Vasilios Karavasilis1, Christos Papadimitriou2, Helen Gogas3, George Kouvatseas4, George Pentheroudakis5, Angelos Koutras6, Christos Christodoulou7, Dimitrios Bafaloukos8, Epaminontas Samantas9, Nikolaos Pisanidis10, Pavlos Papakostas11, Gerasimos Aravantinos12, Charisios Karanikiotis13, Paris Kosmidis14, Dimitrios Pectasides15, Meletios-Athanassios Dimopoulos2, George Fountzilas16. 1. Department of Medical Oncology, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece. Electronic address: karavasv@auth.gr. 2. Department of Clinical Therapeutics, "Alexandra" Hospital, University of Athens School of Medicine, Athens, Greece. 3. First Department of Medicine, "Laiko" General Hospital, University of Athens, Medical School, Athens, Greece. 4. Health Data Specialists Ltd, Athens, Greece. 5. Department of Medical Oncology, Ioannina University Hospital, Ioannina, Greece. 6. Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece. 7. Second Department of Medical Oncology, "Metropolitan" Hospital, Piraeus, Greece. 8. First Department of Medical Oncology, "Metropolitan" Hospital, Piraeus, Greece. 9. Third Department of Medical Oncology, "Agii Anargiri" Cancer Hospital, Athens, Greece. 10. Department of Medical Oncology, IKA Hospital, Thessaloniki, Greece. 11. Department of Medical Oncology, "Hippokration" Hospital, Athens, Greece. 12. Second Department of Medical Oncology, "Agii Anargiri" Cancer Hospital, Athens, Greece. 13. Department of Medical Oncology, 424 Army General Hospital, Thessaloniki, Greece. 14. Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece. 15. Oncology Section, Second Department of Internal Medicine, "Hippokration" Hospital, Athens, Greece. 16. Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Abstract
BACKGROUND: Intensive chemotherapy confers benefit to patients with high-risk early breast cancer (BC). We characterized the feasibility and toxicity profile of anthracycline-containing adjuvant chemotherapy (ACAC) in older women with early BC. PATIENTS AND METHODS: Available data from women who received ACAC for BC in 3 randomized trials were retrieved. We identified women aged >65 years and we examined differences in tolerability and delivery of chemotherapy, toxicity, and treatment outcome. RESULTS: From a total of 2640 patients, we identified 453 patients (17%) as being >65 years old, 89% of whom had tumors that were node-positive, with 77% who were hormone receptor-positive. At least 90% of the planned doses were delivered in 37% of the elderly, compared with 49% in the younger patients (P < .0001). Grade 3 and 4 hematological toxicity was observed in 32% of elderly patients, compared with 21% of the younger (P < .0001). Febrile neutropenia occurred in 4.5% of the elderly patients, as opposed to 2.0% in the younger patients (P < .002). Elderly patients experienced more frequent Grade 3 and 4 fatigue, mucositis, and sensory neuropathy. Relative dose intensities were significantly lower in elderly patients. Treatment discontinuation was not different in the 2 groups. At a median follow-up of 120 months, competing risks analysis showed a significant benefit in disease-free survival for elderly patients. CONCLUSION: Elderly BC patients treated with ACAC derive clinical benefit comparable to that in younger patients, mainly at the cost of increased risk of hematological toxicity. This should be taken into account in decision-making and treatment individualization in high-risk BC patients.
BACKGROUND: Intensive chemotherapy confers benefit to patients with high-risk early breast cancer (BC). We characterized the feasibility and toxicity profile of anthracycline-containing adjuvant chemotherapy (ACAC) in older women with early BC. PATIENTS AND METHODS: Available data from women who received ACAC for BC in 3 randomized trials were retrieved. We identified women aged >65 years and we examined differences in tolerability and delivery of chemotherapy, toxicity, and treatment outcome. RESULTS: From a total of 2640 patients, we identified 453 patients (17%) as being >65 years old, 89% of whom had tumors that were node-positive, with 77% who were hormone receptor-positive. At least 90% of the planned doses were delivered in 37% of the elderly, compared with 49% in the younger patients (P < .0001). Grade 3 and 4 hematological toxicity was observed in 32% of elderly patients, compared with 21% of the younger (P < .0001). Febrile neutropenia occurred in 4.5% of the elderly patients, as opposed to 2.0% in the younger patients (P < .002). Elderly patients experienced more frequent Grade 3 and 4 fatigue, mucositis, and sensory neuropathy. Relative dose intensities were significantly lower in elderly patients. Treatment discontinuation was not different in the 2 groups. At a median follow-up of 120 months, competing risks analysis showed a significant benefit in disease-free survival for elderly patients. CONCLUSION: Elderly BC patients treated with ACAC derive clinical benefit comparable to that in younger patients, mainly at the cost of increased risk of hematological toxicity. This should be taken into account in decision-making and treatment individualization in high-risk BC patients.
Authors: Melisa L Wong; Bruce A Cooper; Steven M Paul; Gary Abrams; Kimberly Topp; Kord M Kober; Margaret A Chesney; Melissa Mazor; Mark A Schumacher; Yvette P Conley; Jon D Levine; Christine Miaskowski Journal: Support Care Cancer Date: 2019-02-15 Impact factor: 3.603
Authors: Melisa L Wong; Junheng Gao; Gita Thanarajasingam; Jeff A Sloan; Amylou C Dueck; Paul J Novotny; Aminah Jatoi; Arti Hurria; Louise C Walter; Christine Miaskowski; Harvey J Cohen; William A Wood; Josephine L Feliciano; Thomas E Stinchcombe; Xiaofei Wang Journal: Oncologist Date: 2020-10-01