Carvedilol for anthracycline cardiomyopathy prevention.

alay et al. (1), in a population of apparently unselected patients eceiving their first 6 cycles of anthracyclines, found in their ontrol group a high incidence of functional cardiomyopathy: 24% f their patients had at the final examination an ejection fraction of 0% or less. This incidence of cardiac dysfunction is higher than he expected one for patients beginning their exposure to anthrayclines (2); this must be clearly explained, because it is the base of he suggested treatment effect: only one patient of the carvedilol roup developed functional cardiomyopathy. The only risk factor or cardiomyopathy development that is apparently present in this elatively young population is a high accumulated dose, with a ean of 513.6 mg/m for adriamycin users and of 770.4 mg/m for pirubicin users, in the control group. The carvedilol-treated group eceived about the same mean doses. Unfortunately, the investigators do not report the standard eviation of the total doses administered. If there is a large ispersion of data, the “nonsignificant” Student t test reported for he comparison of total doses between groups loses confidence. arge dispersion of data in this regard may imply different istribution of total doses, with consequent different risks to both roups, independently of the influence of treatment on cardiac rognosis. When one is trying to reach conclusions with a small set f data, meticulous presentation of both data and appropriate tatistics is mandatory. Also, the total dose of adriamycin and epirubicin appears nusually high in a population naïve to previous anthracycline xposure: we calculate cycles of about 87 mg/m for adriamycin sers and about 130 mg/m for epirubicin users, which are not the sual doses for breast cancer or lymphoma treatment. This also equires clarification.