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Doxorubicin Exposure and Breast Cancer Risk in Survivors of Adolescent and Adult Hodgkin Lymphoma.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2024 Jun 01; Vol. 42 (16), pp. 1903-1913. Date of Electronic Publication: 2024 Feb 15. - Publication Year :
- 2024
-
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.<br />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.<br />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/m <superscript>2</superscript> 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/m <superscript>2</superscript> doxorubicin ( P <subscript>trend</subscript> = .004). The risk increase associated with doxorubicin (yes v no) was not modified by age at first treatment (hazard ratio [HR] <subscript>age <21 years</subscript> , 1.5 [95% CI, 0.9 to 2.6]; HR <subscript>age ≥21 years</subscript> , 1.3 [95% CI, 0.9 to 1.9) or chest RT (HR <subscript>without mantle/axillary field RT</subscript> , 1.9 [95% CI, 1.06 to 3.3]; HR <subscript>with mantle/axillary field RT</subscript> , 1.2 [95% CI, 0.8 to 1.8]).<br />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.
- Subjects :
- Humans
Female
Adolescent
Adult
Middle Aged
Young Adult
Antibiotics, Antineoplastic adverse effects
Incidence
Netherlands epidemiology
Risk Factors
Hodgkin Disease epidemiology
Hodgkin Disease drug therapy
Doxorubicin adverse effects
Doxorubicin administration & dosage
Breast Neoplasms epidemiology
Breast Neoplasms drug therapy
Cancer Survivors statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 42
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 38359378
- Full Text :
- https://doi.org/10.1200/JCO.23.01386