2012年8月31日 讯 /生物谷BIOON/ --运用两种化疗药物治疗乳腺癌的妇女患者可能会遇到比以往研究发现的更多的心脏问题如心脏衰竭等，据Journal of the National Cancer Institute杂志上刊出的一则研究证实。
Risk of Heart Failure in Breast cancer Patients After Anthracycline and trastuzumab treatment: A retrospective cohort Study
Erin J. Aiello Bowles, Robert Wellman, Heather Spencer Feigelson, Adedayo A. Onitilo, Andrew N. Freedman, Thomas Delate,et al
Background Clinical trials demonstrated that women treated for breast cancer with anthracycline or trastuzumab are at increased risk for heart failure and/or cardiomyopathy (HF/CM), but the generalizability of these findings is unknown. We estimated real-world adjuvant anthracycline and trastuzumab use and their associations with incident HF/CM.
Methods We conducted a population-based, retrospective cohort study of 12?500 women diagnosed with incident, invasive breast cancer from January 1, 1999 through December 31, 2007, at eight integrated Cancer Research Network health systems. Using administrative procedure and pharmacy codes, we identified anthracycline, trastuzumab, and other
chemotherapy use. We identified incident HF/CM following chemotherapy initiation and assessed risk of HF/CM with time-varying chemotherapy exposures vs no chemotherapy. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for age at diagnosis, stage, Cancer Research Network site, year of diagnosis, radiation therapy, and comorbidities.
Results Among 12500 women (mean age=60years, range=22–99years), 29.6% received anthracycline alone, 0.9% received trastuzumab alone, 3.5% received anthracycline plus trastuzumab, 19.5% received other chemotherapy, and 46.5% received no chemotherapy. Anthracycline and trastuzumab recipients were younger, with fewer comorbidities than recipients of other chemotherapy or none. Compared with no chemotherapy, the risk of HF/CM was higher in patients treated with anthracycline alone (adjusted HR=1.40, 95% CI=1.11 to 1.76), although the increased risk was similar to other chemotherapy (adjusted HR=1.49, 95% CI=1.25 to 1.77); the risk was highly increased in patients treated with trastuzumab alone (adjusted HR=4.12, 95% CI=2.30 to 7.42) or anthracycline plus trastuzumab (adjusted HR=7.19, 95% CI=5.00 to 10.35).
Conclusions Anthracycline and trastuzumab were primarily used in younger, healthier women and associated with increased HF/CM risk compared with no chemotherapy. This population-based observational study complements findings from clinical trials on cancer treatment safety.