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New-Onset Congestive Heart Failure With Gemcitabine in Ovarian and Other Solid Cancers

Shrum, Kara J. P., MD*; Gill, Sarah E., MD*; Thompson, Laura K., PhD; Blackhurst, Dawn W., DrPh; Puls, Larry E., MD§

American Journal of Clinical Oncology: August 2014 - Volume 37 - Issue 4 - p 364–368
doi: 10.1097/COC.0b013e31827b459a
Original Articles: Gynecologic

Objective: To assess clinical features that may predispose individuals taking gemcitabine to new-onset congestive heart failure.

Methods: A retrospective chart review was conducted with 156 female patients, 51 with ovarian cancer and 105 with breast, lung, pancreas, and bladder cancer, all of whom had received gemcitabine. Patients with new-onset congestive heart failure were compared with patients without new-onset congestive heart failure with the use of Wilcoxon rank-sum test for continuously distributed data and the Fisher exact test for proportions.

Results: Seven patients developed new-onset congestive heart failure (4.5%) during their treatment, which was significantly greater than that reported previously (0.76%). Patients with new-onset congestive heart failure did not differ from other patients in the study for age, weight, gravidity, parity, body mass index, and type of cancer. They also did not differ in history of myocardial infarction, hypertension, prior episodes of congestive heart failure, prior treatment with adriamycin, or use of tobacco. However, diabetes mellitus and coronary artery disease were more common, and all patients who developed new-onset congestive heart failure received >17,000 mg/m2 of gemcitabine. The incidence of new-onset congestive heart failure in this study is significantly higher than previously reported with the use of gemcitabine.

Conclusions: The single-most predictive risk factor for new-onset congestive heart failure in this cohort of patients is the receipt of a minimum dose of 17,000 mg/m2. Therefore, additional follow-up may be necessary for all patients receiving >15,000 mg/m2 of gemcitabine to screen for potential new-onset congestive heart failure.

Departments of *Obstetric and Gynecology

Quality Management, Greenville Hospital System University Medical Center

Department of Biology, Furman University

§Cancer Centers of the Carolinas, Greenville, SC

Presented as a poster at the 40th Annual Meeting of the Society of Gynecologic Oncologists, February 5–8, 2009, San Antonio, TX.

L.E.P. is a member of the Ovarian Advisory Board for Lilly Pharmaceuticals. The other authors declare no conflicts of interest.

Reprints: Sarah E. Gill, MD, Department of Obstetric and Gynecology, Greenville Hospital System University Medical Center, 890 West Faris Rd, MMOB Suite 470, Greenville, SC 29605. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc