BACKGROUND: Elderly breast cancer patients are underrepresented in clinical trials and this leads to a lack of knowledge regarding the tolerance and side effects of modern chemotherapy regimens, especially in dose-dense (dd) or dose-intensified combination. PATIENTS AND METHODS: In this analysis, data from 4 German, randomized (neo-)adjuvant trials, including anthracycline-based chemotherapy, were evaluated for toxicity, compliance and feasibility. Patients were grouped according to age. RESULTS: Of the 4,775 patients, 73.6% were < 60 years, 15.8% were 60-64 years and 10.6% were > 64 years. The patients' compliance decreased with increasing age, the rate of therapy discontinuations was 10.3%; 16.0% were > 64 years old (p < 0.001). The rate of dose reductions also increased with increasing age in the docetaxel/doxorubicin/cyclophosphamide (TAC) (p overall = 0.02) and 5-fluorouracil/epirubicin-cyclophosphamide (FE120C) (p overall < 0.001) treatment groups. Neutropenia grade 3 + 4 in patients of > 64 years was 77% in FE120C- compared to 55% in TAC-treated patients (with primary granulocyte colony-stimulating factors (G-CSFs)). The incidence of febrile neutropenia (FN) was lowest in the regimens without additional taxanes. FN in patients aged > 64 years was lower in the FE120C- than in TAC-and dd-doxorubicin/docetaxel-treated groups. CONCLUSION: The range and intensity of toxicity increased with age. Neutropenia did not increase significantly in the dd groups; the highest rate was seen in FE120C-treated patients. FE120C without G-CSFs is not an option in patients older than 64 years.
BACKGROUND: Elderly breast cancerpatients are underrepresented in clinical trials and this leads to a lack of knowledge regarding the tolerance and side effects of modern chemotherapy regimens, especially in dose-dense (dd) or dose-intensified combination. PATIENTS AND METHODS: In this analysis, data from 4 German, randomized (neo-)adjuvant trials, including anthracycline-based chemotherapy, were evaluated for toxicity, compliance and feasibility. Patients were grouped according to age. RESULTS: Of the 4,775 patients, 73.6% were < 60 years, 15.8% were 60-64 years and 10.6% were > 64 years. The patients' compliance decreased with increasing age, the rate of therapy discontinuations was 10.3%; 16.0% were > 64 years old (p < 0.001). The rate of dose reductions also increased with increasing age in the docetaxel/doxorubicin/cyclophosphamide (TAC) (p overall = 0.02) and 5-fluorouracil/epirubicin-cyclophosphamide (FE120C) (p overall < 0.001) treatment groups. Neutropenia grade 3 + 4 in patients of > 64 years was 77% in FE120C- compared to 55% in TAC-treated patients (with primary granulocyte colony-stimulating factors (G-CSFs)). The incidence of febrile neutropenia (FN) was lowest in the regimens without additional taxanes. FN in patients aged > 64 years was lower in the FE120C- than in TAC-and dd-doxorubicin/docetaxel-treated groups. CONCLUSION: The range and intensity of toxicity increased with age. Neutropenia did not increase significantly in the dd groups; the highest rate was seen in FE120C-treated patients. FE120C without G-CSFs is not an option in patients older than 64 years.
Entities:
Keywords:
Breast cancer; Chemotherapy; Elderly; Side effect; Tolerability
Authors: Xavier Pivot; Andreas Schneeweiss; Shailendra Verma; Christoph Thomssen; José Luis Passos-Coelho; Giovanni Benedetti; Eva Ciruelos; Roger von Moos; Hong-Tai Chang; Anja-Alexandra Duenne; David W Miles Journal: Eur J Cancer Date: 2011-07-15 Impact factor: 9.162
Authors: G von Minckwitz; J-U Blohmer; G Raab; A Löhr; B Gerber; G Heinrich; H Eidtmann; M Kaufmann; J Hilfrich; C Jackisch; I Zuna; S D Costa Journal: Ann Oncol Date: 2005-01 Impact factor: 32.976
Authors: Miguel Martín; Miguel A Seguí; Antonio Antón; Amparo Ruiz; Manuel Ramos; Encarna Adrover; Ignacio Aranda; Alvaro Rodríguez-Lescure; Regina Grosse; Lourdes Calvo; Agustí Barnadas; Dolores Isla; Purificación Martinez del Prado; Manuel Ruiz Borrego; Jerzy Zaluski; Angels Arcusa; Montserrat Muñoz; José M López Vega; José R Mel; Blanca Munarriz; Cristina Llorca; Carlos Jara; Emilio Alba; Jesús Florián; Junfang Li; José A López García-Asenjo; Amparo Sáez; María José Rios; Sergio Almenar; Gloria Peiró; Ana Lluch Journal: N Engl J Med Date: 2010-12-02 Impact factor: 91.245
Authors: Miguel Martin; Tadeusz Pienkowski; John Mackey; Marek Pawlicki; Jean-Paul Guastalla; Charles Weaver; Eva Tomiak; Taher Al-Tweigeri; Linnea Chap; Eva Juhos; Raymond Guevin; Anthony Howell; Tommy Fornander; John Hainsworth; Robert Coleman; Jeferson Vinholes; Manuel Modiano; Tamas Pinter; Shou C Tang; Bruce Colwell; Catherine Prady; Louise Provencher; David Walde; Alvaro Rodriguez-Lescure; Judith Hugh; Camille Loret; Matthieu Rupin; Sandra Blitz; Philip Jacobs; Michael Murawsky; Alessandro Riva; Charles Vogel Journal: N Engl J Med Date: 2005-06-02 Impact factor: 91.245
Authors: Jens Huober; Gunter von Minckwitz; Carsten Denkert; Hans Tesch; Erich Weiss; Dirk Michael Zahm; Antje Belau; Fariba Khandan; Maik Hauschild; Christoph Thomssen; Bernhard Högel; Silvia Darb-Esfahani; Keyur Mehta; Sibylle Loibl Journal: Breast Cancer Res Treat Date: 2010-08-10 Impact factor: 4.872
Authors: Hyman B Muss; Susan Woolf; Donald Berry; Constance Cirrincione; Raymond B Weiss; Daniel Budman; William C Wood; I Craig Henderson; Clifford Hudis; Eric Winer; Harvey Cohen; Judith Wheeler; Larry Norton Journal: JAMA Date: 2005-03-02 Impact factor: 56.272
Authors: G von Minckwitz; S Kümmel; A du Bois; W Eiermann; H Eidtmann; B Gerber; J Hilfrich; J Huober; S D Costa; C Jackisch; S-T Grasshoff; S Vescia; T Skacel; S Loibl; K M Mehta; M Kaufmann Journal: Ann Oncol Date: 2007-09-09 Impact factor: 32.976
Authors: Young Chandler; Jinani C Jayasekera; Clyde B Schechter; Claudine Isaacs; Christopher J Cadham; Jeanne S Mandelblatt Journal: J Natl Cancer Inst Date: 2020-06-01 Impact factor: 13.506
Authors: Kristin E Morrill; Rogelio Robles-Morales; Melissa Lopez-Pentecost; Raigam J Martínez Portilla; Ahlam A Saleh; Meghan B Skiba; Taylor S Riall; Jessica D Austin; Rachel Hirschey; Elizabeth T Jacobs; Lena Spotleson; Timothy P Hanna Journal: BMJ Open Date: 2022-06-28 Impact factor: 3.006
Authors: Richard J Bleicher; Karen Ruth; Elin R Sigurdson; J Robert Beck; Eric Ross; Yu-Ning Wong; Sameer A Patel; Marcia Boraas; Eric I Chang; Neal S Topham; Brian L Egleston Journal: JAMA Oncol Date: 2016-03 Impact factor: 31.777
Authors: C C Hack; P Voiß; S Lange; A E Paul; S Conrad; G J Dobos; M W Beckmann; S Kümmel Journal: Geburtshilfe Frauenheilkd Date: 2015-07 Impact factor: 2.915
Authors: Magdalena Absmaier; Rudolf Napieralski; Tibor Schuster; Michaela Aubele; Axel Walch; Viktor Magdolen; Julia Dorn; Eva Gross; Nadia Harbeck; Aurelia Noske; Marion Kiechle; Manfred Schmitt Journal: Int J Oncol Date: 2018-01-08 Impact factor: 5.650
Authors: Leonidas Georgiou; Nisha Sharma; David A Broadbent; Daniel J Wilson; Barbara J Dall; Anmol Gangi; David L Buckley Journal: Magn Reson Med Date: 2017-04-03 Impact factor: 4.668