Doxorubicin Exposure and Breast Cancer Risk in Survivors of Adolescent and Adult Hodgkin Lymphoma
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| Title: | Doxorubicin Exposure and Breast Cancer Risk in Survivors of Adolescent and Adult Hodgkin Lymphoma |
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| Authors: | Suzanne I.M. Neppelenbroek, Yvonne M. Geurts, Berthe M.P. Aleman, Pieternella J. Lugtenburg, Saskia E. Rademakers, Roel J. de Weijer, Maaike G.A. Schippers, Bastiaan D.P. Ta, Wouter J. Plattel, Josée M. Zijlstra, Richard W.M. van der Maazen, Marten R. Nijziel, Francisca Ong, Erik C. Schimmel, Eduardus F.M. Posthuma, Marie José Kersten, Lara H. Böhmer, Karin Muller, Harry R. Koene, Liane C.J. te Boome, Yavuz M. Bilgin, Eva de Jongh, Cécile P.M. Janus, Flora E. van Leeuwen, Michael Schaapveld |
| Contributors: | Cancer, Verpleegkundig specialisten & PA's, MS Hematologie |
| Source: | J Clin Oncol Journal of Clinical Oncology, 42, 16, pp. 1903-1913 |
| Publisher Information: | American Society of Clinical Oncology (ASCO), 2024. |
| Publication Year: | 2024 |
| Subject Terms: | Adult, 0301 basic medicine, Cancer Research, Adolescent, Netherlands/epidemiology, Breast Neoplasms, Antineoplastic/adverse effects, Young Adult, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Cancer Survivors, Antibiotics, Risk Factors, Humans, Netherlands, Antibiotics, Antineoplastic, Breast Neoplasms/epidemiology, Incidence, ORIGINAL REPORTS, Middle Aged, Hodgkin Disease, 3. Good health, Hodgkin Disease/epidemiology, Oncology, Doxorubicin, Radiation Oncology - Radboud University Medical Center, Female, Doxorubicin/adverse effects, Cancer Survivors/statistics & numerical data |
| Description: | PURPOSE Female Hodgkin lymphoma (HL) survivors treated with chest radiotherapy (RT) at a young age have a strongly increased risk of breast cancer (BC). Studies in childhood cancer survivors have shown that doxorubicin exposure may also increase BC risk. Although doxorubicin is the cornerstone of HL chemotherapy, the association between doxorubicin and BC risk has not been examined in HL survivors treated at adult ages. METHODS We assessed BC risk in a cohort of 1,964 female 5-year HL survivors, treated at age 15-50 years in 20 Dutch hospitals between 1975 and 2008. We calculated standardized incidence ratios, absolute excess risks, and cumulative incidences. Doxorubicin exposure was analyzed using multivariable Cox regression analyses. RESULTS After a median follow-up of 21.6 years (IQR, 15.8-27.1 years), 252 women had developed invasive BC or ductal carcinoma in situ. The 30-year cumulative incidence was 20.8% (95% CI, 18.2 to 23.4). Survivors treated with a cumulative doxorubicin dose of >200 mg/m2 had a 1.5-fold increased BC risk (95% CI, 1.08 to 2.1), compared with survivors not treated with doxorubicin. BC risk increased 1.18-fold (95% CI, 1.05 to 1.32) per additional 100 mg/m2 doxorubicin ( Ptrend = .004). The risk increase associated with doxorubicin (yes v no) was not modified by age at first treatment (hazard ratio [HR]age , 1.5 [95% CI, 0.9 to 2.6]; HRage ≥21 years, 1.3 [95% CI, 0.9 to 1.9) or chest RT (HRwithout mantle/axillary field RT, 1.9 [95% CI, 1.06 to 3.3]; HRwith mantle/axillary field RT, 1.2 [95% CI, 0.8 to 1.8]). CONCLUSION This study shows that treatment with doxorubicin is associated with increased BC risk in both adolescent and adult HL survivors. Our results have implications for BC surveillance guidelines for HL survivors and treatment strategies for patients with newly diagnosed HL. |
| Document Type: | Article Other literature type |
| File Description: | application/pdf |
| Language: | English |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.23.01386 |
| Access URL: | https://pubmed.ncbi.nlm.nih.gov/38359378 https://hdl.handle.net/https://repository.ubn.ru.nl/handle/2066/308188 https://doi.org/10.1200/JCO.23.01386 https://research.rug.nl/en/publications/5dcf08df-f8e0-40d2-a52f-3c4c343c6fe4 https://doi.org/10.1200/JCO.23.01386 https://hdl.handle.net/11370/5dcf08df-f8e0-40d2-a52f-3c4c343c6fe4 https://cris.maastrichtuniversity.nl/en/publications/f95456c3-ea4c-41a2-8bfe-137c2b472bdd https://doi.org/10.1200/JCO.23.01386 https://dspace.library.uu.nl/handle/1874/454214 https://hdl.handle.net/1887/4209245 https://pure.amsterdamumc.nl/en/publications/5919595d-d71e-4fb4-af4d-9ebae4b16023 https://doi.org/10.1200/JCO.23.01386 https://repository.ubn.ru.nl//bitstream/handle/2066/308188/308188.pdf https://repository.ubn.ru.nl/handle/2066/308188 |
| Rights: | CC BY taverne URL: http://creativecommons.org/licenses/by/4.0/Licensed under the Creative Commons Attribution 4.0 License: http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) |
| Accession Number: | edsair.doi.dedup.....4f5cc37e5e2059fef85c5d70991b3b80 |
| Database: | OpenAIRE |
Nájsť tento článok vo Web of Science | Abstract: | PURPOSE Female Hodgkin lymphoma (HL) survivors treated with chest radiotherapy (RT) at a young age have a strongly increased risk of breast cancer (BC). Studies in childhood cancer survivors have shown that doxorubicin exposure may also increase BC risk. Although doxorubicin is the cornerstone of HL chemotherapy, the association between doxorubicin and BC risk has not been examined in HL survivors treated at adult ages. METHODS We assessed BC risk in a cohort of 1,964 female 5-year HL survivors, treated at age 15-50 years in 20 Dutch hospitals between 1975 and 2008. We calculated standardized incidence ratios, absolute excess risks, and cumulative incidences. Doxorubicin exposure was analyzed using multivariable Cox regression analyses. RESULTS After a median follow-up of 21.6 years (IQR, 15.8-27.1 years), 252 women had developed invasive BC or ductal carcinoma in situ. The 30-year cumulative incidence was 20.8% (95% CI, 18.2 to 23.4). Survivors treated with a cumulative doxorubicin dose of >200 mg/m2 had a 1.5-fold increased BC risk (95% CI, 1.08 to 2.1), compared with survivors not treated with doxorubicin. BC risk increased 1.18-fold (95% CI, 1.05 to 1.32) per additional 100 mg/m2 doxorubicin ( Ptrend = .004). The risk increase associated with doxorubicin (yes v no) was not modified by age at first treatment (hazard ratio [HR]age , 1.5 [95% CI, 0.9 to 2.6]; HRage ≥21 years, 1.3 [95% CI, 0.9 to 1.9) or chest RT (HRwithout mantle/axillary field RT, 1.9 [95% CI, 1.06 to 3.3]; HRwith mantle/axillary field RT, 1.2 [95% CI, 0.8 to 1.8]). CONCLUSION This study shows that treatment with doxorubicin is associated with increased BC risk in both adolescent and adult HL survivors. Our results have implications for BC surveillance guidelines for HL survivors and treatment strategies for patients with newly diagnosed HL. |
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| ISSN: | 15277755 0732183X |
| DOI: | 10.1200/jco.23.01386 |