Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;6(1):e1681.
doi: 10.1002/cnr2.1681. Epub 2022 Jul 18.

Cardiac events among patients with sarcoma treated with doxorubicin by method of infusion: A real-world database study

Lee D Cranmer  1 , Lisa M Hess  2 , Tomoko Sugihara  3 , Howard G Muntz  4
Affiliations

Cardiac events among patients with sarcoma treated with doxorubicin by method of infusion: A real-world database study

Lee D Cranmer et al. Cancer Rep (Hoboken). 2023 Jan.

Abstract

Background: Administration of doxorubicin by continuous intravenous (CIV) infusion, versus bolus (BOL) administration, has been proposed to mitigate the risk of cardiac events. This study used real-world data to explore the association between mode of doxorubicin administration and duration of treatment, time-to-treatment failure (TTF), and cardiac events.

Methods: Occurrence of cardiac events after initiation of BOL versus CIV doxorubicin for sarcoma in the International Business Machines MarketScan claims database were compared. Duration of doxorubicin treatment, TTF, and time-to-first-cardiac event (TCE) were evaluated using Kaplan-Meier method and unadjusted and adjusted Cox regression models.

Results: A total of 196 patients were included in the BOL group and 399 in the CIV group. In unadjusted analyses, there were significant differences between BOL versus CIV for duration of doxorubicin treatment (median 1.4 vs. 2.1 months, p = .002), TTF (median 8.8 vs. 5.6 months, p = .002), and TCE (medians not reached, p = .03). Adjusting for baseline covariates, only TTF remained significant (hazard ratio: 0.71, 95% confidence interval 0.59-0.86, p = .0004), favoring BOL.

Conclusions: While the risk of cardiac complications was higher with BOL in unadjusted analysis, the risk was no longer present in the adjusted analysis. While we cannot draw causal inferences due to the retrospective, nonrandomized study design, these data suggest that replacing BOL with prolonged CIV administration has not been effective as a strategy to mitigate cardiac events, given community standards of oncologic practice.

Keywords: anthracycline; bolus; cardiotoxicity; doxorubicin; infusion; retrospective; sarcoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Patient eligibility diagram.
FIGURE 2
FIGURE 2
Duration of doxorubicin treatment by mode of doxorubicin administration, unadjusted analysis. (A) (top): Primary analysis ignoring gap periods. (B) (bottom): Sensitivity analysis up to the first 90‐day gap.
FIGURE 3
FIGURE 3
Time to treatment failure by mode of doxorubicin infusion, unadjusted analysis.
FIGURE 4
FIGURE 4
Time to first cardiac event by mode of doxorubicin infusion, unadjusted analysis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Judson I, Verweij J, Gelderblom H, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first‐line treatment of advanced or metastatic soft‐tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol. 2014;15(4):415‐423. - PubMed
    1. Ryan CW, Merimsky O, Agulnik M, et al. PICASSO III: a phase III, placebo‐controlled study of doxorubicin with or without Palifosfamide in patients with metastatic soft tissue sarcoma. J Clin Oncol. 2016;34(32):3898‐3905. - PubMed
    1. Tap WD, Papai Z, van Tine BA, et al. Doxorubicin plus evofosfamide versus doxorubicin alone in locally advanced, unresectable or metastatic soft‐tissue sarcoma (TH CR‐406/SARC021): an international, multicentre, open‐label, randomised phase 3 trial. Lancet Oncol. 2017;18(8):1089‐1103. - PMC - PubMed
    1. von Hoff DD, Layard MW, Basa P, et al. Risk factors for doxorubicin‐lnduced congestive heart failure. Ann Intern Med. 1979;91(5):710‐717. - PubMed
    1. Minow RA, Benjamin RS, Lee ET, Gottlieb JA. Adriamycin cardiomyopathy—risk factors. Cancer. 1977;39(4):1397‐1402. - PubMed

Publication types