Dose-Dense Chemotherapy for Breast Cancer May Impair Lung Function
A previous study indicated a reduction in DLCO for patients patients with breast cancer who underwent a DDC regimen consisting of 4 biweekly cycles of doxorubicin and cyclophosphamide.
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Carbon monoxide diffusing capacity (DLCO) may be significantly reduced long-term postadjuvant dose-dense chemotherapy (DDC) among patients with breast cancer, according to findings presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting.
In a previous study, investigators enrolled 34 patients with breast cancer who underwent a DDC regimen consisting of 4 biweekly cycles of doxorubicin and cyclophosphamide. Patients underwent pulmonary function tests (PFT) at baseline, during, and after completion of DDC; none of the patients had a history of lung disease. Results showed there was an absolute mean reduction of 16.4% in DLCO, and nearly 62% of patients had a relative decrease of greater than 20% from baseline. Long-term pulmonary and oncologic outcomes, however, were not yet assessable.
For this long-term analysis, 25 of the 34 patients who did not have disease recurrence underwent PFT after median 24 months from DDC administration.
PFT results showed DLCO was significantly reduced (81.9%) compared to baseline mean DLCO (92.0%; P<.001), but was significantly improved compared to PFT measures collected post-DDC (75.6%; P=.003).
Five patients (20%) still had DLCO reduction of greater than 20% from baseline.
DLCO recovery was negatively correlated with advanced age. No associations were observed between DLCO recovery and time lapsed until the later PFT or additional therapies, and DDC-associated DLCO reduction did not impact disease recurrence or survival.
The authors concluded that “while some patients recover and return to their baseline pulmonary function, others will endure lasting diminished diffusion capacity. Practitioners and patients should be aware of these long term effects of treatment, especially regarding older women or those with preexisting lung disease.”
ReferenceLandman Y, Stemmer SM, Kramer MR, et al. A prospective long term follow up of pulmonary diffusion capacity reduction caused by dose dense chemotherapy in breast cancer patients. J Clin Oncol.2018;36(suppl):e2537.