Skip to main content Skip to main navigation menu Skip to site footer

The effects of cyclophosphamide, adriamycin and 5-fluorouracil chemotherapy on blood cells and cardiac hemodynamics in breast carcinoma patients: a case study at Dr. Kariadi General Hospital, Semarang, Indonesia

  • Sibin Chandra ,
  • Djoko Handojo ,


Background: One of the treatment modalities for breast malignancy is chemotherapy. Chemotherapy could kill cancer cells as well as normal cells, including blood cells and cardiac cells. Early detection of adverse events includes myelosuppression and cardiotoxicity could reduce morbidity and mortality rates. This study aims to determine a decrease in blood cells and cardiac hemodynamics in breast carcinoma patients who underwent Cyclophosphamide, Adriamycin, and 5-Fluorouracil (CAF) chemotherapy.

Methods: Analytical prospective observational study with breast carcinoma. The measurements were Haemoglobin (Hb), Hematocrit (Ht), Erythrocyte (Ery), Leukocyte (Leu), Platelet (Plt), Left Ventricle Ejection Fraction (LVEF), Stroke Volume (SV), and Cardiac Output (CO) until 3rd cycles of chemotherapy. Data were analyzed using SPSS version 17 for Windows.

Results: There were 35 subjects enrolled in this study. Decreases in Hb, Ht, Ery, Leu, and Plt after the 1st, 2nd, and 3rd cycles of chemotherapy were statistically significant (p<0.05). There was a statistically significant decrease in LVEF, SV, and CO after the 1st, 2rd and 3rd cycles of chemotherapy (p<0.05). Besides, the SV and CO after the 2nd and 3rd cycles of chemotherapy were also decreased significantly (p<0.05).

Conclusions: There is a decrease in blood cells (Hb, Ht, Ery, Leu, Plt) and cardiac hemodynamics (LVEF, SV, and CO) in breast carcinoma patients who underwent CAF chemotherapy.


  1. Richie RC, Swanson JO. Breast cancer: a review of the literature. J Insur Med. 2003;35(2):85-101.
  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
  3. Saxena N, Hartman M, Bhoo-Pathy N, et al. Breast cancer in South East Asia: comparison of presentation and outcome between a middle income and a high income country. World J Surg. 2012;36(12):2838-2846.
  4. Anwar SL, Raharjo CA, Herviastuti R, Dwianingsih EK, Setyoheriyanto D, Avanti WS, et al. Pathological profiles and clinical management challenges of breast cancer emerging in young women in Indonesia: a hospital-based study. BMC Womens Health. 2019;19(1):28.
  5. Henley SJ, Singh SD, King J, Wilson RJ, O'Neil ME, Ryerson AB. Invasive Cancer Incidence and Survival - United States, 2013. MMWR Morb Mortal Wkly Rep. 2017;66(3):69-75.
  6. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Peto R, Davies C, Godwin J, Gray R, Pan HC, et al. Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 2012;379(9814):432-44.
  7. Martin M, Villar A, Sole-Calvo A, Gonzalez R, Massuti B, Lizon J, et al. Doxorubicin in combination with fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1, 21) versus methotrexate in combination with fluorouracil and cyclophosphamide (i.v. CMF regimen, day 1, 21) as adjuvant chemotherapy for operable breast cancer: a study by the GEICAM group. Ann Oncol. 2003;14(6):833-42.
  8. Cummings FJ, Gelman R, Horton J. Comparison of CAF versus CMFP in metastatic breast cancer: analysis of prognostic factors. J Clin Oncol. 1985;3(7):932-940.
  9. Lenneman CG, Sawyer DB. Cardio-Oncology: An Update on Cardiotoxicity of Cancer-Related Treatment. Circ Res. 2016;118(6):1008-1020.
  10. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(36):2768-2801.
  11. Wiranata S, Anjani IAW, Saputra IPGS, Sadvika IGAS, Prabawa IPY, Supadmanaba IG, et al. Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as a Stage Determination in Breast Cancer. Open Access Maced J Med Sci. 2020;8(B):1058-1063.
  12. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
  13. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-163.
  14. Collaborative Group on Hormonal Factors in Breast Cancer. Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies. Lancet Oncol. 2012;13(11):1141-1151.
  15. Fujimoto RHP, Koifman RJ, Silva IFD. Survival rates of breast cancer and predictive factors: a hospital-based study from western Amazon area in Brazil. Cien Saude Colet. 2019;24(1):261-273.
  16. Tecza K, Pamula-Pilat J, Lanuszewska J, Butkiewicz D, Grzybowska E. Pharmacogenetics of toxicity of 5-fluorouracil, doxorubicin and cyclophosphamide chemotherapy in breast cancer patients. Oncotarget. 2018;9(10):9114-9136.
  17. Iqubal A, Iqubal MK, Sharma S, et al. Molecular mechanism involved in cyclophosphamide-induced cardiotoxicity: Old drug with a new vision. Life Sci. 2019;218:112-131.
  18. Das UN. Free radicals: biology and relevance to disease. J Assoc Physicians India. 1990;38(7):495-498.
  19. Buck I, Morceau F, Grigorakaki C, Dicato M, Diederich M. Linking anemia to inflammation and cancer: the crucial role of TNFalpha. Biochem Pharmacol. 2009;77(10):1572-1579.
  20. Cella D, Kallich J, McDermott A, Xu X. The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol. 2004;15(6):979-986.
  21. Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, et al. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. 2018;36(25):2647-2655.
  22. Parameswaran R, Lunning M, Mantha S, Devlin S, Hamilton A, Schwartz G, et al. Romiplostim for management of chemotherapy-induced thrombocytopenia. Support Care Cancer. 2014;22(5):1217-22.
  23. Gripp EA, Oliveira GE, Feijó LA, Garcia MI, Xavier SS, Sousa AS. Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment. Arq Bras Cardiol. 2018;110(2):140-150.
  24. Octavia Y, Tocchetti CG, Gabrielson KL, Janssens S, Crijns HJ, Moens AL. Doxorubicin-induced cardiomyopathy: from molecular mechanisms to therapeutic strategies. J Mol Cell Cardiol. 2012;52(6):1213-1225.
  25. Spinale FG. Myocardial matrix remodeling and the matrix metalloproteinases: influence on cardiac form and function. Physiol Rev. 2007;87(4):1285-1342.
  26. Hong YM, Lee H, Cho MS, Kim KC. Apoptosis and remodeling in adriamycin-induced cardiomyopathy rat model. Korean J Pediatr. 2017;60(11):365-372.
  27. Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM. Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant. 2000;15 Suppl 3:14-18.
  28. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27(9):911-39.

How to Cite

Chandra, S., & Handojo, D. (2021). The effects of cyclophosphamide, adriamycin and 5-fluorouracil chemotherapy on blood cells and cardiac hemodynamics in breast carcinoma patients: a case study at Dr. Kariadi General Hospital, Semarang, Indonesia. Bali Medical Journal, 10(1), 111–118.




Search Panel