The incidence of cardiomyopathy in BRCA1 and BRCA2 mutation carriers after anthracycline-based adjuvant chemotherapy.

PURPOSE: Breast cancer remains the fourth-leading cause of death in the United States. Nearly 10% of breast cancers are hereditary, with deleterious mutations in BRCA1 and BRCA2 genes being the leading cause. Anthracycline chemotherapy, used commonly for breast cancer, carries cardiotoxicity risk. Recent studies demonstrated anthracycline-induced cardiac failure in homozygous BRCA2-deficient mice and increased rates of heart failure in homozygous BRCA1-deficient mice following ischemic insult. Therefore, we conducted a retrospective matched cohort study to determine the rates of anthracycline-induced cardiomyopathy in breast cancer patients with germline mutation in BRCA1 or BRCA2 genes compared to age-matched patients without a BRCA1 or BRCA2 gene mutation. METHODS: The primary endpoint was to determine the rate of cardiomyopathy defined as either congestive heart failure or asymptomatic decline in ejection fraction to <50%. A total of 102 breast cancer patients who were BRCA gene mutation carriers (55 BRCA1, 45 BRCA2, and two with both), who received anthracycline-based chemotherapy were compared to a matched cohort of breast cancer patients with wild-type BRCA gene status. RESULTS: We found a 4.9% rate of cardiomyopathy in the BRCA mutation carriers and 5.2% in the matched controls (p = 0.99). Cox proportional hazards model showed that only trastuzumab and hypertension were significantly associated with the development of cardiomyopathy in both groups (p < 0.05). CONCLUSIONS: Given the limitations of a retrospective study, we saw no increased risk of cardiotoxicity among breast cancer patients with BRCA1 and/or BRCA2 gene mutations treated with standard doses of anthracycline compared to the general population.

Eosinophilic small bowel enteritis in response to folinic acid, fluorouracil, and oxaliplatin chemotherapy.

A 70-year-old woman being treated with folinic acid, fluorouracil, and oxaliplatin (FOLFOX) therapy for relapsed colon cancer metastatic to the lung presented to the hospital with a 1-week history of abdominal pain, anorexia, a 1-day history of diarrhea, and a fever of 101°F. Neutropenia and a peripheral eosinophilia were present, and computed tomogram of the abdomen showed thickening of the wall of a segment of small bowel with luminal stenosis. Colonoscopy and double-balloon small bowel enteroscopy found a stenosis in the ileum that upon biopsy revealed small bowel eosinophilic enteritis. She improved rapidly with the administration of dexamethasone. A Medline search for reports of small bowel eosinophilic enteritis in response to any of the components of FOLFOX was unrevealing.