A COMPARATIVE STUDY OF CARDIOVASCULAR TOXICITY OF EPIRUBICIN AND DOXORUBICIN IN PATIENTS WITH BREAST CANCER
Authors:   SI «National Scientific Center “The M. D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Scienses of Ukraine”», Dovganych N. V. , Kozhukhov S. M. ,   SI «National Scientific Center “The M. D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Scienses of Ukraine”», Smolanka I. I. ,   National Cancer Institute of the Ministry of Health of Ukraine, Lygyrda O. F. ,   National Cancer Institute of the Ministry of Health of Ukraine, Bazyka О. Ye. ,   SI «National Scientific Center “The M. D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Scienses of Ukraine”», Lyalkin S. A. ,   National Cancer Institute of the Ministry of Health of Ukraine
Published: December 2024

Patients with breast cancer (BC) are at high risk of cardiotoxicity (CT) due to combination of anticancer treatment. Cardio-vascular (СV) complications lead to the delay or discontinuation of anticancer therapy, which significantly worsens the prognosis. Anthracyclines (AC) are the main drugs included in most anticancer treatment regimens. Detecting signs of CT at the early stages, when there is no cardiac dysfunction and signs of heart failure (HF), is important to develop individualized monitoring and prevention strategies in BC patients.
The objective of the study was to investigate the incidence of CT of epirubicin and doxorubicin in the complex BC therapy, based on monitoring of left ventricular ejection fraction (LV EF), diastolic function of the LV, and to investigate the incidence of signs and symptoms of HF.
Material and Methods. The study included 44 BC patients. We analyzed the dynamics of LV EF before the start of antitumor treatment and within 6 months. A decrease in LVEF of ≥ 10 % (percentage points) or below its threshold value (< 50 %) was considered to be a CT criterion. Patients were divided into 2 groups. Group 1 included patients with BC who received epirubicin (n = 18), group 2 included BC patients who received doxorubicin in the chemotherapy regimen (n = 26).
Results. Before the start of chemotherapy, LV ejection fraction was normal and did not differ significantly between the groups. During follow-up at 6 months after the start of treatment, in group 1 the proportion of patients with CT according to LV EF was 11.1 %, compared with 23.1 % in group 2 (p < 0.05). The number of patients with signs and symptoms of HF was 34.6 % in group 2, that was significantly higher compared with that in group 1 – 11.1 % (p < 0.05). According to the correlation analysis, LV EF in group 2 had an inverse correlation with the dose of doxorubicin (r = -0.67, p < 0.05), with heart rate (r = -0.59, p < 0.05), and with body mass index (r = -0.55, p < 0.05), indicating a negative effect of doxorubicin on the CV system in patients with BC.
Conclusions. The results of the study indicate a significantly higher incidence of LV EF reduction as a CT criterion when using doxorubicin in the chemotherapy regimens compared with epirubicin. Myocardial damage as a result of chronic cardiotoxicity is accompanied by a decrease in LV systolic function and a significantly higher incidence of HF.
Key words: breast cancer; cardiotoxicity; epirubicin; doxorubicin; heart failure.