you may not want to read this one if you got anthracyclines

[Lani]

looking closer, for more subtle changes , they found a higher incidence of heart changes.This may not be so dire (it is just not known): Since they were looking for subclinical (those without symptoms / signs) changes, it is unclear whether these would ever become symptomatic and how they would progress( or improve) with time, but since they are talking of actual remodelling of the heart muscle in the left ventricle it sounds pretty irreversible

I post this not to scare but to help those wondering whether to go with AC then T or TCH and without information on their TOPO II level (still "not actually proven in a large clinical trial" as the lingo goes, make up their minds based on available evidence of the risks, benefits:

Minerva Cardioangiol. 2007 Dec;55(6):711-20.
Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy.

Lotrionte M, Palazzoni G, Natali R, Comerci G, Abbate A, Loperfido F, Biondi-Zoccai G.
Division of Heart Failure and Cardiac Rehabilitation, Cardiovascular Department, Catholic University of the Sacred Heart Rome, Italy gbiondizoccai@gmail.com.
AIM: Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We evaluated the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling. METHODS: Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and >6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Fifty-six patients were included (follow-up 9+/-6 months). RESULTS: At baseline, no patient had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or New York Heart Association (NYHA) >1. Follow-up overall analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all P<0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10 (17.9%) in group 3. All groups shared similar conditions at baseline. Patients with adverse LV-TDI remodelling had significant increases in EDD and ESD, as well as a significantly decreased LVEF (all P<0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (P<0.05). CONCLUSION: Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.
PMID: 18091640 [PubMed - in process]

[AlaskaAngel]

Hi Lani,

As one who received an anthracycline, even though there is a fairly remote possibility that I might have been one of those who actually benefitted from it cancer-wise (given that I am NED at 5 years out), I still find it sort of insane that it took so long for a study like this to be done... BEFORE the use of anthracyclines was so widely adopted for mass treatment purposes. But I appreciate your posting it all the same.

I didn't have Herceptin on top of the anthracycline, although so far that seems to allow some reversal of loss of cardiac function.

AlaskaAngel

[juanita]

I only did 2 of the tac, before doing cmf and 1 yr herceptin. So far my pcp who has been testing my heart because of high cholesterol and family heart history says it looks really really good. We'll see what he says next time.

[Lani]

I think the reason the study wasn't done earlier is the way clinical trials are devised. They have to give the "standard of care" treatment and then add something to it, so noone can complain they were somehow short-changed.

But when it turns out the "standard of care" which improved the survival characteristics when one looked at ALL breast cancers lumped together, only really benefitted 8% -24% of patients (depending if you go along with Dr. Slamon) was terribly skewed by the improved survival in a group(her2+s) which the other treatments (endocrine, etc) were less effective in, it makes you want to demand that they start dividing breast cancer into three groups (to start with):her2+s, triple negatives, and everyone else and try to find the best treatment for each group, develop a new standard of care for each, and then both add to the treatment, and subtract from it ie, see if a smaller dose of tykerb or a shorter course of herceptin would be just as effective. The latter type of trial is the hardest to do: legal and financial implications, of course.

It was not until her2 testing started being done, and then being done more exactly and consistently, that these trends began to appear.

Lesson: support biomarker research to help decipher how many types of bc there really are and detect the best treatment for each subtype.

At that point Becky's advocate handbook will be able to give better statistics to help the newly diagnosed make the best choices.

[Mary Jo]

Hi Lani,

I found this post interesting. Especially in light of the fact that my new Onc. decided he wanted a MUGA done to see if there was any long term damage done to my heart from my rounds of A/C (meaning the "A") and my year of herceptin.

Before chemo began my ECHO was 68. Four months into herceptin - after adriamycin was completed and taxol was being used, another MUGA was done. Then my LVEF was 50 something (lower I remember but can't remember the exact number) My old onc. never did another MUGA for the remainder of my herceptin so I don't know if my LVEF went any lower. Now (Sept. 07 - which also is 11 months after herceptin was finished) my MUGA score (LVEF) was 62.

So, thankfully, my heart recovered nicely from it all and we hope and pray that I benefit from the adriamycin part of my treatment. At least we know I wasn't harmed by it.

Thanks for all your information.

Mary Jo

[suzan w]

My MUGA scores remained constant in the mid 60's throughout all my treatments...4 A/C and a year of herceptin. This "news" about Adriamycin has all come out since I had my treatment. Hopefully I will still be OK as I travel along my life's path!

[hutchibk]

My story is similar to SusanW. My MUGA remained consistent after Adria for almost 5 months and after that eventually Herceptin for 20 months. No indication of anything heartwise currently on Tykerb, but my onc and I have talked about an eventual MUGA or Echo just to keep an eye on things.

[Sheila]

Brenda
It may be chemo brain, but didn't they say in San Antonio that effects from the Adriamycin on the heart can show up years later way past treatment? It seemed to intensify when Herceptin was added. If so, it may make future monitoring necessary.

[hutchibk]

Thanks for the reminder, Sheila. We heard so much valuable info in SA that I can't remember it all!

[Joanne S]

RE: ''At that point Becky's advocate handbook will be able to give better statistics to help the newly diagnosed make the best choices.''

Thanks Lani. Please advise where to find Becky's Handbook.
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[Sheila]

Heyyyyyyy Brenda
Did I hear it correctly...thats what I am asking...I don't want to get it wrong...we heard so much in SA, hard to remember it all and get it in order. This was one of the talks that Dr Slamon gave...or one of the heated discussions.....
Don't work too hard!

[jhandley]

Hi
I had adriamycin in 2001 as part of the taxotere trial. I had 3 tx A, 3 tx T and 3 CMF. 4 and a half years later I had a recurrence in the same breast with one 15 mm liver spot. I had 6 taxol and herceptin and am now on herceptin alone. I have been in remission for 2.3 years this time. I take co-enzyme Q10 100-200 mg daily and my LVEF have remained between 60 and 68. However when I switched to echo's rather than MUGA (less needles) a small effusion (fluid) was noted and also some trivial leakage in some of my valves. These were not there 7 years ago when I had an echo before going on the trial.

Has anyone else noticed these changes? They wont show up on a MUGA but will on an echo I believe.
Regards
Jackie

[Cathya]

Jackie;

I have had trouble with my MUGA's and had an echo done and some heart tests done following my stroke (not caused by the heart.....lacunar stroke). In any case the value in my left ventricle was staged at a one....it doesn't close all the way and leaks a bit. This is like cancer in the grading as I understand it. I was not aware of any heart issues prior to my diagnosis and treatment of bc.

Cathy

[Lani]

I don't know about the institution where you had the echos, but at Stanford
(one of the first if not the first to utilize 3d echos on patients) until about one year ago they were only used on some patients in a research setting, All their echo machines are now 3 d (3 dimensional ) echocardiograph machines.

3d machines show much more detail than the old 2d ones.

So saying something was not seen 7 years ago with an echo and now is may be like saying Kirk Douglas didn't have dimple in his chin until this Christmas because your old TV didn't provide good enough resolution for you to detect it and you just got a HDTV, which does.

Hope this helps

[Lani]

I was referring to the Handbook Becky suggested starting as a New Year's project in her thread...Just search for handbook Becky in the search tool, and I am sure you'll find it!

[dhealey]

My mother was treated with adramycin in the late 1980's for her breast cancer, I do not know if she was her2 pos. as they didn't know anything about it back then. She took adramycin on 2 different occasions about 5 years apart. The year before she died she had heart valve damage due to the adramycin. I was treated with A/C at the beginning of my treatement and now will be finishing up on the herceptin next week. My echos have shown my ejection fractions to stay in the low 60's. On the last echo though there was some mild valve deterioration. Wish I had thought about this before treatment, that being said though I walk 4-7 miles every day to keep my heart in shape I do believe this helps. I think treatment will be alot different for those newly diagnosised