How do the benefits of epirubicin against breast cancer stack up against the risk of late-onset heart failure?
Breast cancer is the most prevalent cancer in women and anthracycline-based chemotherapy, epirubicin in particular, is one of the most effective treatments for breast cancer. Recent guidelines published in the US and in Europe identify treatment with anthracyclines as a risk factor for heart failure.1,2 Authors of a new study point out that the risk of lateâonset HF is debatable and mainly based on observational studies; the objective of this study was to evaluate the effect of anthracyclineâbased chemotherapy on longâterm risk of clinical HF.
The post-hoc analysis included 980 Danish women with early breast cancer (mean age at diagnosis 48 years); patients were randomized to recieve combination chemotherapy that included or did not include epirubicin. Median followup 16.9 years.
Risk of HF was 3 times as high in the epirubicin group vs non-epirubicin group (p<.01); however, overall survival benefit with epirubicin was preserved despite increased HF incidence.
The bottom line: The number needed to harm to cause one extra case of HF was almost double the number needed to treat to save one life with epirubicin.