Anthracycline exposure in young adults who previously received cancer treatment is associated with a significantly elevated risk for heart failure.

Long-term follow-up of the TRAIN-2 study shows that patients with stage II or III HER2-positive breast cancer who receive neoadjuvant chemotherapy and dual HER2-blockade derive no survival benefit from the addition of anthracyclines.

The cumulative incidence of CHF in patients given anthracyclines compared with the cancer-free controls began to diverge within 1 year of follow-up (1.81 vs 0.09%) and continued for at least 25 years of follow-up (14.69 vs 9.02%).

End-of-study findings from the GIM2 trial indicate that adjuvant anthracyclines plus taxane chemotherapy for high-risk early breast cancer should be given in a dose-dense regimen and should not include fluorouracil.

However, concerns regarding cardiovascular toxicity and leukemia with anthracyclines has led to increasing use of non-anthracycline-based chemotherapy, he added.

Cardioprotective pharmacologic therapy may be effective against anthracycline-related subclinical heart damage in women with nonmetastatic breast cancer, with bisoprolol potentially offering greater benefits than ramipril, interim SAFE study data suggest.

Concurrent use of the ACE inhibitor lisinopril could help reduce the risk for left ventricular ejection fraction decline in women receiving trastuzumab and anthracyclines for HER2-positive early breast cancer, suggests US research.

Using data from the 283 patients who comprised the development cohort, the investigators identified the following eight clinical and geriatric factors that independently predicted grade 3–5 chemotherapy toxicity, and assigned them weighted points to form the CARG–BC score: Planned treatment duration greater than 3 months (4 points);  Falls in past 6 months (4 points); Stage II–III disease (3 points);  Abnormal liver function (3 points); Low hemoglobin (≤12 g/dL in women, ≤13 g/dL in men; 3 points); Limited ability to walk (3 points);  Lack of social support (3 points); and Planned use of anthracyclines (1 point).

They drew on linked administrative data to identify all women in Ontario, Canada, aged at least 66 years who had no history of heart failure and received anthracyclines and/or trastuzumab within a year of being diagnosed with early-stage breast cancer between 2007 and 2017.

But she said that the universal use of anthracyclines in all patients was “a downside of the trial” when studies like TRAIN-2, also presented at the meeting and reported by medwireNews , question “whether we need anthracyclines.” medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group 2020 ASCO Annual Meeting; 29–31 May

The PHOEBE trial enrolled patients who had already received treatment with trastuzumab and taxanes, with or without anthracyclines, and up to two lines of chemotherapy for metastatic disease (median, 1).

Mariana Chavez-MacGregor and co-researchers, from The University of Texas MD Anderson Cancer Center in Houston, USA, similarly observed a higher risk for heart failure with versus without anthracyclines and also with trastuzumab use; the corresponding adjusted HRs were 1.53 and 2.01.

No such improvement was observed with either the ACE inhibitor or the beta blocker in the subgroup of patients who had not received anthracyclines.

Among women with breast cancer treated with anthracyclines in the adjuvant or advanced setting, outcomes are better for those with low versus high levels of mitochondrial DNA in their primary tumors, suggests an analysis of biobank specimens.

Additionally, 41% of participants had been treated with anthracyclines and 77% had undergone autologous stem-cell transplantation.

The majority of women (89%) received chemotherapy, typically anthracyclines with or without taxanes.

The doxorubicin conjugate aldoxorubicin could be a suitable alternative to standard therapies for patients with relapsed or refractory soft tissue sarcoma, say researchers.

In this roundup we report on three phase III trials, two investigating trastuzumab emtansine in HER2-positive breast cancer and one assessing tailored neoadjuvant therapy in soft tissue sarcoma, and also on an analysis of postmarketing safety events.