The effect of HCV serological status on Doxorubicin based chemotherapy induced toxicity and disease-free survival in breast cancer patients

Background: Breast cancer and HCV are two frequent diseases in Egypt. There is a considerable probability of concurrent affection. This concurrence creates a subpopulation, which needs special evaluation and care. Objective: To evaluate a subset of Egyptian breast cancer patients receiving Doxorubicin based adjuvant chemotherapy, with HCV seropositivity (group 2) compared to HCV seronegative patients (group 1). Methods: 102 breast cancer patients, planned to receive Doxorubicin based adjuvant chemotherapy, at the Oncology Department, Alexandria Faculty of Medicine, were recruited since June 2009. Pretreatment evaluation included serological testing for HCV. FAC Adjuvant chemotherapy was given for six cycles. Results: HCV seropositivity was detected in 52 cases. Two cases in the seropositive group developed toxic hepatitis and discontinued treatment and follow up. The remaining 100 patients suffered comparable toxicities, except for more frequent liver enzyme elevations in the seropositive group. Diarrhea was also more frequent in the seropositive group. Treatment delays and dose reductions were more frequently observed in the seropositive group. The 36 month disease-free survival and relapse pattern were not significantly different between the two groups.Conclusion: Patients receiving chemotherapy should undergo screening for the virus. Most patients with HCV were able to tolerate chemotherapy and continue the initial chemotherapy plan, without a significant change in the toxicity profile or the natural course of their malignancy. Dose or regimen adjustments may be of help to less tolerant patients. A preemptive 10% initial Doxorubicin dose reduction might reduce the frequency of severe toxicity for selected patients. The assistance of a gastroenterologist in HCV positive breast cancer patients, planned for chemotherapy is important.