Skip to main content

Adjuvant Chemotherapy

  • Chapter
  • First Online:
Management of Breast Cancer in Older Women

Abstract

Age constitutes the greatest risk factor for breast cancer - the median age at the time of diagnosis is 61, and the median age at the time of death from breast cancer is 69 (Ries et al. 2008). In patients with non-metastatic disease, adjuvant chemotherapy to decrease the risk of relapse and mortality remains a consideration regardless of age. Although substantial evidence supports the use of adjuvant chemotherapy in postmenopausal women, limited data specifically address the risks and benefits of adjuvant chemotherapy for patients over the age of 65, and even less data are available for those over 75.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Colleoni M, Price KN, Castiglione-Gertsch M et al. (1999) Mortality during adjuvant treatment of early breast cancer with cyclophosphamide, methotrexate, and fluorouracil. Lancet 354(9173):130-131

    Google Scholar 

  • Crawford J, Althaus B, Armitage J et al (2007) Myeloid growth factors. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 5(2):188-202

    Google Scholar 

  • Crivellari D, Bonetti M, Castiglione-Gertsch M et al (2000) Burdens and benefits of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: the international breast cancer study group trial VII. J Clin Oncol 18:1412-1422

    PubMed  CAS  Google Scholar 

  • De Maio E, Gravina A, Pacilio C et al (2005) Compliance and toxicity of adjuvant CMF in elderly breast cancer patients: a single-center experience. BMC Cancer 5:30

    Article  PubMed  Google Scholar 

  • 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 18:521-529

    Article  PubMed  CAS  Google Scholar 

  • Diab SG, Elledge RM, Clark GM (2000) Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 92:550-556

    Google Scholar 

  • Dominguez-Ventura A, Cassivi SD, Allen MS et al (2007) Lung cancer in octogenarians: factors affecting long-term survival following resection. Eur J Cardiothorac Surg 32:370-374

    Article  PubMed  Google Scholar 

  • Elkin EB, Hurria A, Mitra N et al (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 24:2757-2764

    Article  PubMed  Google Scholar 

  • Fargeot P, Bonneterre J, Roche H et al (2004) Disease-free survival advantage of weekly epirubicin plus tamoxifen versus tamoxifen alone as adjuvant treatment of operable, node-positive, elderly breast cancer patients: 6-year follow-up results of the French Adjuvant Study Group 08 trial. J Clin Oncol 22:4674-4682

    Article  CAS  Google Scholar 

  • Gianni L, Herman EH, Lipshultz SE et al (2008) Anthracycline cardiotoxicity: from bench to bedside. J Clin Oncol 26:3777-3784

    Article  PubMed  Google Scholar 

  • Giordano SH, Duan Z, Kuo Y-F et al (2006a) Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol 24:2750-2756

    Article  PubMed  Google Scholar 

  • Giordano SH, Duan Z, Hortobagyi G, Goodwin J (2006b) Congestive heart failure (CHF) in older women treated with anthracycline (A) chemotherapy (C). Journal of Clinical Oncology, 2006 ASCO annual meeting proceedings part I, vol. 24(18S) (June 20 supplement), p 521

    Google Scholar 

  • Gridelli C, Maione P, Illiano A et al (2007) Cisplatin plus gemcitabine or vinorelbine for elderly patients with advanced non small-cell lung cancer: The MILES-2P studies. J Clin Oncol 25:4663-4669

    Article  PubMed  CAS  Google Scholar 

  • Early Breast 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 365:1687-1717

    Article  Google Scholar 

  • Harbeck N, Jakesz R (2007) St. Gallen 2007: breast cancer treatment consensus report. Breast Care 2:130-134

    Article  Google Scholar 

  • Hurria A, Fleming MT, Baker SD et al (2006a) Pharmacokinetics and toxicity of weekly docetaxel in older patients. Clin Cancer Res 12:6100-6105

    Article  PubMed  CAS  Google Scholar 

  • Hurria A, Rosen C, Hudis C et al (2006b) Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study. J Am Geriatr Soc 54:925-931

    Article  PubMed  Google Scholar 

  • Hurria A, Goldfarb S, Rosen C et al (2006c) Effect of adjuvant breast cancer chemotherapy on cognitive function from the older patient’s perspective. Breast Cancer Res Treat 98:343-348

    Article  PubMed  CAS  Google Scholar 

  • Hurria A, Wong FL, Villaluna D et al. (2008) Influence of age and health status on oncologists’ and geratricians’ adjuvant treatment recommendations for older adults with breast cancer. J Clin Oncol 26(20 Suppl); abstr 9643

    Google Scholar 

  • Jones SE, Savin MA, Holmes FA et al (2006) Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. J Clin Oncol 24:5381-5387

    Article  PubMed  CAS  Google Scholar 

  • Jones S, Holmes F, O’Shaughnessy J, et al. (2008) Extended follow-up and analysis by age of the US oncology adjuvant trial 9735: docetaxel/cyclophosphamide is associated with an overall survival benefit compared to doxorubicin/cyclophosphamide and is well-tolerated in women 65 or older. Breast Cancer Res Treat (abstr 12)

    Google Scholar 

  • Muss HB, Woolf S, Berry D et al (2005) Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA 293:1073-1081

    Article  PubMed  CAS  Google Scholar 

  • Muss HB, Berry DA, Cirrincione C et al (2007) Toxicity of older and younger patients treated with adjuvant chemotherapy for node-positive breast cancer: the Cancer and Leukemia Group B experience. J Clin Oncol 25:3699-3704

    Article  PubMed  CAS  Google Scholar 

  • Muss HB, Berry DA, Cirrincione CT et al (2009) Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med 360:2055-2065

    Article  PubMed  CAS  Google Scholar 

  • Patt DA, Duan Z, Fang S et al (2007) Acute myeloid leukemia after adjuvant breast cancer therapy in older women: understanding risk. J Clin Oncol 25:3871-3876

    Article  PubMed  Google Scholar 

  • Perez EA, Suman VJ, Davidson NE et al (2008) Cardiac safety analysis of doxorubicin and cyclophosphamide followed by paclitaxel with or without trastuzumab in the North Central Cancer Treatment Group N9831 adjuvant breast cancer trial. J Clin Oncol 26:1231-1238

    Article  PubMed  CAS  Google Scholar 

  • Ries LAG, Melbert D, Krapcho M et al. (2008) 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

  • Romond EH, Perez EA, Bryant J et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353:1673-1684

    Article  PubMed  CAS  Google Scholar 

  • Slamon D, Eiermann W, Robert N, et al. (2007) BCIRG 006: 2nd interim analysis phase III randomized trial comparing doxorubicin and cyclophosphamide followed by docetaxel (ACT) with doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab (ACTH) with docetaxel, carboplatin and trastuzumab (TCH) in Her2neu positive early breast cancer patients. Breast Cancer Res Treat 2007 (abstr 52)

    Google Scholar 

  • Smith TJ, Khatcheressian J, Lyman GH et al (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24:3187-3205

    Article  PubMed  CAS  Google Scholar 

  • Tan-Chiu E, Yothers G, Romond E et al (2005) Assessment of cardiac dysfunction in a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel, with or without trastuzumab as adjuvant therapy in node-positive, human epidermal growth factor Receptor 2-overexpressing breast cancer: NSABP B-31. J Clin Oncol 23:7811-7819

    Article  PubMed  CAS  Google Scholar 

  • Thomas S, Rich MW (2007) Epidemiology, pathophysiology, and prognosis of heart failure in the elderly. Heart Fail Clin 3:381-387

    Article  PubMed  Google Scholar 

  • Wildiers H, Kunkler I, Biganzoli L et al (2007) Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 8:1101-1115

    Article  PubMed  Google Scholar 

Download references

Acknowledgment of Research Support

Dr. Hurria’s efforts are supported by K23 AG026749-01 (Paul Beeson Career Development Award in Aging Research) and American Society of Clinical Oncology-Association of Specialty Professors-Junior Development Award in Geriatric Oncology.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London

About this chapter

Cite this chapter

Pal, S.K., Vora, N., Hurria, A. (2010). Adjuvant Chemotherapy. In: Reed, M., Audisio, R. (eds) Management of Breast Cancer in Older Women. Springer, London. https://doi.org/10.1007/978-1-84800-265-4_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-84800-265-4_16

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84800-264-7

  • Online ISBN: 978-1-84800-265-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics