Feasibility and toxicity of dose-dense adjuvant chemotherapy in older women with breast cancer

Brief Report

Abstract

Introduction The objective of this study was to examine the feasibility and toxicity of adjuvant dose-dense chemotherapy in older women with breast cancer. Methods A search of the Memorial Sloan-Kettering Cancer Center (MSKCC) breast cancer database was performed to identify all patients age 60 and older who underwent an initial consultation with a breast medical oncologist between October 1, 2002 and June 28, 2005. Inclusion criteria were: (1) age ≥ 60, (2) follow-up care obtained at MSKCC, (3) intent to treat with adjuvant dose-dense AC-T (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 every 2 weeks for 4 cycles followed by paclitaxel 175 mg/m2 every 2 weeks for 4 cycles, with white blood cell growth factor support). Results One hundred sixty-two patients (mean age 66, range 60–76) with breast cancer, stages I (n = 5), II (n = 111), and III (n = 46) according to the sixth edition of the AJCC staging system, were included in this analysis. Forty-one percent (n = 67) experienced a grade 3 or 4 toxicity, 9% a grade 3 infection (n = 14), 6% grade 3 fatigue (n = 9), 5% neutropenic fever (n = 8), and 4% thromboembolic events (n = 7). Twenty-two percent (n = 36) did not complete the planned 8 cycles of treatment. There was no statistically significant association between age and either toxicity or treatment discontinuation. In multivariate analysis including age, pretreatment hemoglobin, and comorbidity, the presence of comorbidity (Charlson score ≥ 1) and a lower baseline hemoglobin score were associated with an increased risk of any grade 3 or 4 toxicity. Conclusions We found that the risk of toxicity depended more on comorbid medical conditions and baseline hemoglobin value than age in this cohort of older adults receiving dose-dense adjuvant chemotherapy.

Keywords

Breast Cancer Dose-Dense Chemotherapy Older Patient 

References

  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ (2007) Cancer statistics, 2007. CA Cancer J Clin 57(1):43–66PubMedCrossRefGoogle Scholar
  2. 2.
    Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2005. National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2005/, based on November 2007 SEER data submission, posted to the SEER web site, 2008
  3. 3.
    Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer- treatment trials. N Engl J Med 341(27):2061–2067. doi:10.1056/NEJM199912303412706 PubMedCrossRefGoogle Scholar
  4. 4.
    Muss HB, Woolf S, Berry D et al (2005) Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA 293(9):1073–1081. doi:10.1001/jama.293.9.1073 PubMedCrossRefGoogle Scholar
  5. 5.
    Citron ML, Berry DA, Cirrincione C et al (2003) Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21(8):1431–1439. doi:10.1200/JCO.2003.09.081 PubMedCrossRefGoogle Scholar
  6. 6.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. doi:10.1016/0021-9681(87)90171-8 PubMedCrossRefGoogle Scholar
  7. 7.
    Early Beast Cancer Trialists’ Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717. doi:10.1016/S0140-6736(05)66544-0 CrossRefGoogle Scholar
  8. 8.
    Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285(7):885–892. doi:10.1001/jama.285.7.885 PubMedCrossRefGoogle Scholar
  9. 9.
    Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120(2):104–110PubMedGoogle Scholar
  10. 10.
    Frasci G, Lorusso V, Panza N et al (2000) Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 18(13):2529–2536PubMedGoogle Scholar
  11. 11.
    Du X, Goodwin JS (2001) Patterns of use of chemotherapy for breast cancer in older women: findings from Medicare claims data. J Clin Oncol 19(5):1455–1461PubMedGoogle Scholar
  12. 12.
    Elkin EB, Hurria A, Mitra N, Schrag D, Panageas KS (2006) Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol 24(18):2757–2764. doi:10.1200/JCO.2005.03.6053 PubMedCrossRefGoogle Scholar
  13. 13.
    Dees EC, O’Reilly S, Goodman SN et al (2000) A prospective pharmacologic evaluation of age-related toxicity of adjuvant chemotherapy in women with breast cancer. Cancer Invest 18(6):521–529. doi:10.3109/07357900009012191 PubMedCrossRefGoogle Scholar
  14. 14.
    Reuben DB, Rubenstein LV, Hirsch SH, Hays RD (1992) Value of functional status as a predictor of mortality: results of a prospective study. Am J Med 93(6):663–669. doi:10.1016/0002-9343(92)90200-U PubMedCrossRefGoogle Scholar
  15. 15.
    Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16(4):1582–1587PubMedGoogle Scholar
  16. 16.
    Eagles JM, Beattie JA, Restall DB, Rawlinson F, Hagen S, Ashcroft GW (1990) Relation between cognitive impairment and early death in the elderly. BMJ 300(6719):239–240PubMedCrossRefGoogle Scholar
  17. 17.
    Wolfson C, Wolfson DB, Asgharian M et al (2001) A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 344(15):1111–1116. doi:10.1056/NEJM200104123441501 PubMedCrossRefGoogle Scholar
  18. 18.
    Seeman TE, Kaplan GA, Knudsen L, Cohen R, Guralnik J (1987) Social network ties and mortality among the elderly in the Alameda County Study. Am J Epidemiol 126(4):714–723PubMedGoogle Scholar
  19. 19.
    Penninx BW, Guralnik JM, Ferrucci L, Simonsick EM, Deeg DJ, Wallace RB (1998) Depressive symptoms and physical decline in community-dwelling older persons. JAMA 279(21):1720–1726. doi:10.1001/jama.279.21.1720 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  1. 1.NewYork-Presbyterian HospitalNew YorkUSA
  2. 2.Memorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.City of HopeDuarteUSA

Personalised recommendations