Change in cycle 1 to cycle 2 haematological counts predicts toxicity in older patients with breast cancer receiving adjuvant chemotherapy Journal Article


Authors: Hurria, A.; Brogan, K.; Panageas, K. S.; Jakubowski, A.; Zauderer, M.; Pearce, C.; Norton, L.; Howard, J.; Hudis, C.
Article Title: Change in cycle 1 to cycle 2 haematological counts predicts toxicity in older patients with breast cancer receiving adjuvant chemotherapy
Abstract: Purpose: To determine the association between changes in complete blood counts and grade 3 or 4 toxicities from cycle 1 to cycle 2 during adjuvant chemotherapy in women ≥65 years of age with breast cancer. Design and methods: A retrospective review was performed on 1405 patients ≥65 years of age who were treated for primary invasive breast cancer at Memorial Sloan-Kettering Cancer Center between January 1998 and December 2000. From this cohort, we identified patients with stage I-III breast cancer who received adjuvant chemotherapy: cyclophosphamide, methotrexate and fluorouracil (CMF) or the anthracycline-based regimens doxorubicin and cyclophosphamide (AC) or AC followed by paclitaxel (AC-T). Patients were excluded from the analysis if they had a prior history of breast cancer or chemotherapy, or if they had no baseline blood counts available for review. Toxicities, dose modification and causality were recorded. Results: The 104 patients who met our criteria had received either CMF (n = 58; mean age 70.6 years, range 65-78) or an anthracycline-based regimen (n = 46; mean age 68.9 years, range 65-77). Of these patients, 50% experienced treatment delay or treatment-related grade 3 or 4 toxicity. A decrease in white blood cell count and absolute neutrophil count from cycle 1 to cycle 2 was associated with grade 3 or 4 haematological toxicity, febrile neutropenia, hospitalisation and initiation of filgrastim for secondary prophylaxis. A decrease in haemoglobin was associated with febrile neutropenia and hospitalisation. Advanced age was not associated with a significant change in complete blood counts, other than a decline in absolute neutrophil count in patients receiving CMF. Conclusions: In this cohort of older patients who received chemotherapy for breast cancer, changes in blood counts from cycle 1 to cycle 2 were associated with increased risk of treatment-related grade 3 or 4 toxicity. © 2005 Adis Data Information BV. All rights reserved.
Keywords: cancer chemotherapy; controlled study; aged; retrospective studies; major clinical study; review; doxorubicin; fluorouracil; drug safety; antineoplastic agents; paclitaxel; chemotherapy, adjuvant; methotrexate; breast cancer; erythropoietin; blood toxicity; cyclophosphamide; breast neoplasms; risk assessment; febrile neutropenia; hospitalization; disease severity; statistical significance; neutrophil; blood cell count; anthracycline derivative; recombinant granulocyte colony stimulating factor; drug induced disease
Journal Title: Drugs & Aging
Volume: 22
Issue: 8
ISSN: 1170-229X
Publisher: Adis International Ltd  
Date Published: 2005-01-01
Start Page: 709
End Page: 715
Language: English
DOI: 10.2165/00002512-200522080-00007
PUBMED: 16060720
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 3" - "Export Date: 24 October 2012" - "CODEN: DRAGE" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Clifford Hudis
    848 Hudis
  2. Larry Norton
    581 Norton
  3. Katherine S Panageas
    331 Panageas
  4. Jane E Howard
    22 Howard
  5. Carol Pearce
    5 Pearce
  6. Anju Hurria
    3 Hurria