Patterns of toxicity in older patients with breast cancer receiving adjuvant chemotherapy Journal Article

Authors: Hurria, A.; Brogan, K.; Panageas, K. S.; Pearce, C.; Norton, L.; Jakubowski, A.; Zauderer, M.; Howard, J.; Hudis, C.
Article Title: Patterns of toxicity in older patients with breast cancer receiving adjuvant chemotherapy
Abstract: Objective. To retrospectively determine the relationship of age to toxicity from adjuvant chemotherapy for breast cancer. Design and Methods. We identified 1405 consecutive patients age 65 or older with primary invasive breast cancer who were seen at Memorial Sloan-Kettering Cancer Center from January 1998 to December 2000. Patients selected from this cohort for analysis were aged 65 or older at diagnosis; received their follow-up care at Memorial Sloan-Kettering Cancer Center; had stage I, II, or III breast cancer; and received adjuvant chemotherapy consisting of CMF (cyclophosphamide, methotrexate, and 5-fluorouracil), an anthracycline-based regimen (AC [doxorubicin and cyclophosphamide], or AC-T [AC and paclitaxel or docetaxel]). Exclusion criteria included prior chemotherapy or previous breast cancer. Results. One hundred thirty-two patients were included in this study, with a mean age of 70 (range 65-79). Comorbidity measured by the Charlson comorbidity index was low: score 0 (83%), 1 (12%), 2 (5%); with stages: I(18%), IIA (41%), IIB (27%), IIIA (8%), IIIB (6%), T1Nx (1%). Patients receiving an anthracycline-based regimen were more likely to experience grade 3 or 4 toxicity (p=0. 01), require hospitalization (p<0.001), and/or develop febrile neutropenia (p<0.001). Treatment delays due to myelosuppression occurred more frequently in patients receiving CMF (p<0.001). The type of chemotherapy regimen (anthracycline compared to CMF) was a better predictor for toxicity than increased age or comorbidity score. Conclusions. In this cohort of older patients with breast cancer, the risk for toxicity from adjuvant chemotherapy depended more on the type of regimen (anthracycline vs. CMF) than the patient's chronological age. © Springer 2005.
Keywords: controlled study; aged; retrospective studies; major clinical study; fatigue; neutropenia; doxorubicin; fluorouracil; cancer combination chemotherapy; diarrhea; hypertension; patient selection; united states; paclitaxel; cancer adjuvant therapy; cancer patient; chemotherapy, adjuvant; chemotherapy; methotrexate; cancer grading; breast cancer; bone marrow suppression; blood toxicity; leukopenia; nausea; neuropathy; antineoplastic combined chemotherapy protocols; dehydration; cohort analysis; cyclophosphamide; age factors; breast neoplasms; prediction; risk; docetaxel; febrile neutropenia; syncope; cancer invasion; cancer center; depression; hospitalization; thrombosis; breast carcinoma; comorbidity; scoring system; multivariate analysis; age distribution; drug cytotoxicity; anthracyclines; geriatric patient; brain hemorrhage; ureter obstruction; older patient; heart supraventricular arrhythmia
Journal Title: Breast Cancer Research and Treatment
Volume: 92
Issue: 2
ISSN: 0167-6806
Publisher: Springer  
Date Published: 2005-07-01
Start Page: 151
End Page: 156
Language: English
DOI: 10.1007/s10549-005-1410-8
PUBMED: 15986124
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 25" - "Export Date: 24 October 2012" - "CODEN: BCTRD" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Clifford Hudis
    848 Hudis
  2. Larry Norton
    581 Norton
  3. Arti Hurria
    35 Hurria
  4. Katherine S Panageas
    331 Panageas
  5. Jane E Howard
    22 Howard
  6. Carol Pearce
    5 Pearce