Anthracycline-induced cardiotoxicity in patients with early stage breast cancer: The Canadian cancer trials group (NCIC CTG) MA.21 experience.
Bibliographic record
Abstract
1016 Background: Anthracycline containing chemotherapy (An-CT) has led to improved clinical outcomes in women with early breast cancer (EBC); however cardiotoxicity (CTox) can occur acutely or years later. We report the incidence of CTox in women with EBC who participated in a large randomized phase III trial of 3 different An-CT regimens: cyclophosphamide (C) epirubicin (E) fluorouracil (F); dose dense EC followed by paclitaxel (T); and Adriamycin (A) and C followed by T. Methods: Women (≤60 years) were randomized to one of: Arm A – CEF (E: 60mg/m2 and F days 1 and 8 x 6); Arm B - EC/T (E: 120mg/m2 q2 weeks x 6 followed by T q 3 weeks x 4); Arm C - AC/T (A: 60mg/m2q3 weeks x 4 followed by T q3 weeks x 4). Left ventricular ejection fraction (LVEF) was measured at baseline by echocardiogram (ECHO) (19%) or MUGA (81%), then yearly x 5. CTox was defined as at least 10% decline in LVEF to below 50%. Left ventricular dysfunction (LVD) was defined as: mild (LVEF 40-50%); moderate/severe (LVEF < 40%). Congestive heart failure (CHF) was reported using the NCI Common Toxicity Criteria V.2.0 - cardiac LVF Grades 3 or 4. Results: 2104 women were accrued from 12/2000-04/2005. Mean change in LVEF (0 to 5 years): Arm A (63 to 57%;p<0.0001); Arm B: (63 to 59%: P< 0.0001); Arm C: (63 to 61%; p<0.0001). Conclusions: Pts treated with An-CT remain at risk of CTox up to 5 years after completing treatment. Higher rates of An-CT-induced LVD, CHF, and CTox were observed in the dose intense E treatment arms. While the use of An-CT in BC has been declining, large numbers of women previously treated with An-CT remain at risk for late CTox. Surveillance strategies are needed to guide appropriate identification and monitoring of this patient population. Clinical trial information: NCT00014222.Cardiotoxicity in patients with EBC at 5 years after treatment. Treatment Arm A (CEF) B (EC/T) C (AC/T) No. % No % No. % No. of women 701 33.3 701 33.3 702 33.3 Compliance with LVEF monitoring 575 82.0 589 84.0 548 78.0 Cardiotoxicity (p<0.0001) 38 6.6 24 4.1 7 1.3 Left Ventricular Dysfunction (LVD) Mild LVD (p<0.0001) 48 11.9 31 7.6 13 3. 4 Moderate/severe LVD(p=0.60) 4 0.9 2 0.5 2 0.6 Congestive Heart Failure (CHF) During treatment (p=0.87) 3 0.4 2 0.3 2 0.3 Delayed (p=0.0005) 21 3.0 5 0.7 6 0.9
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".