Doxorubicin-induced congestive heart failure in elderly patients with metastatic breast cancer, with long-term follow-up: the M.D. Anderson experience

Purpose: Correlation between aging and doxorubicin-induced congestive heart failure in patients with metastatic breast cancer was studied to determine whether doxorubicin-induced congestive heart failure in elderly patients w ith metastatic breast cancer is a clinically significant issue. Methods: Th is was a retrospective study with a median follow-up of 16.8 years. The set ting was a comprehensive cancer center in a large city. A group of 682 cons ecutive patients with metastatic breast cancer presented to The University of Texas M.D. Anderson Cancer Center between 1973 and 1980. All patients re ceived doxorubicin by bolus infusion. Patients in group 1 (n = 538) were ag ed 50 to 64 years; patients in group 2 (n = 144) were aged 65 years and old er. Medical records of all patients were reviewed. Patients who had congest ive heart failure were identified and analyzed. The diagnosis of doxorubici n-induced congestive heart failure was made and confirmed by a cardiologist at the time of its development. The main outcome measure was the cumulativ e probability of developing doxorubcin-induced congestive heart failure in elderly patients with metastatic breast cancer compared to a younger age gr oup. Results: In group 1, 33 patients, and in group 2, 13 patients develope d doxorubicin-related congestive heart failure. The cumulative doses of dox orubicin administered to patients with congestive heart failure were 410 mg /m(2) (range 150-550 mg/m(2)) and 400 (range 100-570 mg/m2), respectively. The time interval from the last date of doxorubicin treatment to the develo pment of congestive heart failure was, respectively, 5 months (range < 1-65 months) and 9 months (range <1-28 months). There was no statistically sign ificant difference between the two congestive heart failure subgroups, nor were we able to identify risk factors that could have increased the risk of congestive heart failure among these patients. Conclusion: Older patients with metastatic breast cancer and no significant comorbidity can be treated with doxorubicin-based chemotherapy with no added risk of developing conge stive heart failure beyond that in the younger age group.