Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer.

PURPOSE: Limited data are available on long-term cardiac safety of adjuvant anthracycline chemotherapy in breast cancer patients over age 65 years. We evaluated rates and predictors of congestive heart failure (CHF) in this population. PATIENTS AND METHODS: We used the Surveillance, Epidemiology, and End Results Medicare database and included women with no history of CHF who were age 66 to 80 years and diagnosed with stage I to III breast cancer from 1992 to 2002. Cumulative rates of CHF were estimated, and multivariable Cox regression analysis was used to determine factors associated with the development of CHF. RESULTS: A total of 43,338 women were included. Anthracycline-treated women were younger, with fewer comorbidities and more advanced disease than women who received nonanthracycline or no chemotherapy (P < .001 for each). The adjusted hazard ratio (HR) for CHF was 1.26 (95% CI, 1.12 to 1.42) for women aged 66 to 70 treated with anthracycline compared with other chemotherapy. For women aged 71 to 80, adjuvant chemotherapy type was not associated with CHF. The following baseline characteristics were significant predictors of CHF: age (HR, 1.79 per 10 years; 95% CI, 1.66 to 1.93), black race (HR, 1.40; 95% CI, 1.30 to 1.50), trastuzumab treatment (HR, 1.46; 95% CI, 1.21 to 1.77), hypertension (HR, 1.45; 95% CI, 1.39 to 1.52), diabetes (HR, 1.74; 95% CI, 1.66 to 1.83), and coronary artery disease (HR, 1.58; 95% CI, 1.39 to 1.79). Left-sided radiotherapy did not confer an elevated risk of CHF (HR, 1.04; 95% CI, 0.98 to 1.11). CONCLUSION: Women aged 66 to 70 years who received adjuvant anthracyclines had significantly higher rates of CHF. The difference in rates of CHF continued to increase through more than 10 years of follow-up.

Nanoparticle albumin-bound paclitaxel for treatment of metastatic breast cancer.

Two taxanes, paclitaxel and docetaxel, are among the most widely used chemotherapeutic agents in solid tumor oncology, with efficacy against tumors of the breast, lung, head and neck, ovary, prostate, stomach and urothelium. The taxanes have been studied extensively and have been proven effective for treating early and advanced breast cancer. However, paclitaxel and docetaxel are both highly hydrophobic compounds, requiring synthetic solvents for parenteral administration. The solvents in commercially available preparations cause life-threatening toxic effects and decreased efficacy, and they are inconvenient to administer. Nanoparticle albumin-bound paclitaxel (nabP) is a novel, solvent-free formulation of paclitaxel. With nabP, in contrast to standard paclitaxel, life-threatening hypersensitivity reactions have not been observed, and it can be administered safely without steroid and antihistamine premedication. Furthermore, nabP exploits cellular and tumor transport mechanisms to preferentially target tumor cells. Data from phase III studies of metastatic breast cancer demonstrated higher response rates, longer time to progression and an improved toxicity profile for nabP compared with standard paclitaxel. The U.S. Food and Drug Administration approved nabP in late 2004 for treatment of metastatic breast cancer after failure of an anthracycline-based regimen.