Use of paclitaxel in patients with pre-existing cardiomyopathy: A review of our experience

Cardiac toxicity is frequently the indication for discontinuation of an ant hracycline in patients with tumors which remain anthracycline-sensitive. Du ring the 1990s, the most frequently used second-line agents at the Yale Can cer Center (YCC) were the taxanes. The goal of this retrospective analysis was to determine the effect of paclitaxel on cardiac function in patients w ith cardiomyopathy. YCC outpatient clinic pharmacy order forms were used to identify all patients who had received paclitaxel between December 1995 an d November 1997. The clinic records of those patients with a left ventricul ar ejection fraction (LVEF) of less than or equal to 50% were reviewed to d etermine the temporal relation between the decreased LVEF and paclitaxel th erapy. In addition, clinic records were examined for evidence of prior doxo rubicin therapy and history of prior cardiac disease. Between December 1995 and November 1997, 225 patients were treated with paclitaxel in the YCC ou tpatient clinic. Nine patients had LVEF less than or equal to 50% (mean 37% ) prior to initiation of paclitaxel therapy. Six of these patients had equi librium radionuclide angiocardiographic (ERNA) scans following completion o f paclitaxel, In these 6 patients, the mean change in LVEF was +6% (range - 3% to +29%). Four patients had improved LVEF following paclitaxel (mean 11% , range 2% to 29%), while 2 patients experienced a decrease in LVEF followi ng paclitaxel treatment (mean 2.5%). The 3 patients who did not have ERNA s cans following paclitaxel therapy had no clinical evidence of congestive he art failure. Our experience confirms the results of prior studies that pacl itaxel can be safely administered in patients with underlying cardiac dysfu nction. (C) 2001 Wiley-Liss, Inc.