title: Maximizing the Benefit-Cost Ratio of Anthracyclines in Metastatic Breast Cancer: Case Report of a Patient with a Complete Response to High-Dose Doxorubicin.
abstract: Despite the clinical efficacy of anthracycline agents such as doxorubicin, dose-limiting cardiac toxicities significantly limit their long-term use. Here, we present the case of a 33-year-old female patient with extensive metastatic ER+/PR+/HER2- mucinous adenocarcinoma of the breast, who was started on doxorubicin/cyclophosphamide therapy after progressing on paclitaxel and ovarian suppressor goserelin with aromatase inhibitor exemestane. The patient was comanaged by cardiology, who carefully monitored measures of cardiac function, including EKGs, serial echocardiograms, and profiling of lipids, troponin, and pro-BNP every 2 months. The patient was treated with the cardioprotective agent dexrazoxane, and changes in cardiac markers [e.g. decreases in ejection fraction (EF)] were immediately addressed by therapeutic intervention with the ACE inhibitor lisinopril and beta-blocker metoprolol. The patient had a complete response to doxorubicin therapy, with a cumulative dose of 1,350 mg/m2, which is significantly above the recommended limits, and to our knowledge, the highest dose reported in literature. Two and a half years after the last doxorubicin cycle, the patient is asymptomatic with no cardiotoxicity and an excellent quality of life. This case highlights the importance of careful monitoring and management of doxorubicin-mediated cardiotoxicity, and that higher cumulative doses of anthracyclines can be considered in patients with ongoing clinical benefit.
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Shee
authors.affiliation: Department of Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Kono
authors.affiliation: Department of Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Susan P
authors.initials: SP
authors.lastname: D'Anna
authors.affiliation: Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Seltzer
authors.affiliation: Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Lu
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Miller
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Hematology/Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Chamberlin
keywords: Anthracycline; Cardio-oncology; Cardiotoxicity; Complete response; Doxorubicin; Metastatic breast cancer