Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer Journal Article

Authors: Muss, H. B.; Woolf, S.; Berry, D.; Cirrincione, C.; Weiss, R. B.; Budman, D.; Wood, W. C.; Henderson, I. C.; Hudis, C.; Winer, E.; Cohen, H.; Wheeler, J.; Norton, L.
Article Title: Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer
Abstract: Context: Adjuvant chemotherapy improves survival for patients with local-regional breast cancer, but healthy older patients at high risk of recurrence are frequently not offered adjuvant chemotherapy, and the benefit of adjuvant chemotherapy in older patients is uncertain. Objective: To compare the benefits and toxic effects of adjuvant chemotherapy among breast cancer patients in age groups of 50 years or younger, 51 to 64 years, and 65 years or older. Design and Setting: Retrospective review of data from 4 randomized trials that accrued patients from academic and community medical centers between 1975 and 1999. Median follow-up for all patients was 9.6 years. All trials randomized patients to different regimens, doses, schedules, and durations of chemotherapy and all had a treatment arm with doses or schedules that were regarded to be "high" and potentially more toxic. Patients: A total of 6487 women with lymph node-positive breast cancer; 542 (8%) patients were 65 years or older and 159 (2%) were 70 years or older. Main Outcome Measure: Comparison of disease-free survival, overall survival, and treatment-related mortality among different age groups. Results Multivariate analysis showed that smaller tumor size, fewer positive lymph nodes, more chemotherapy, and tamoxifen use were all significantly (P<.001) related to longer disease-free and overall survival. There was no association between age and disease-free survival. Overall survival was significantly (P<.001) worse for patients aged 65 or older because of death from causes other than breast cancer. Thirty-three deaths (0.5% of all patients) were attributed to treatment, and older women had higher treatment-related mortality. Older women and younger women derived similar reductions in breast cancer mortality and recurrence from regimens containing more chemotherapy. Conclusion: Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health.
Keywords: survival; cancer survival; aged; middle aged; survival analysis; retrospective studies; acute granulocytic leukemia; prednisone; clinical trial; review; doxorubicin; fluorouracil; paclitaxel; cancer adjuvant therapy; comparative study; chemotherapy, adjuvant; methotrexate; drug megadose; lymph node metastasis; antineoplastic agent; lymphatic metastasis; low drug dose; controlled clinical trial; breast cancer; tumor volume; randomized controlled trial; antineoplastic combined chemotherapy protocols; cyclophosphamide; vincristine; age factors; breast neoplasms; retrospective study; cancer mortality; thiotepa; age; risk assessment; myelodysplastic syndrome; randomized controlled trials; thromboembolism; adjuvant chemotherapy; cardiotoxicity; breast tumor; lymph node; tamoxifen; multivariate analysis; age distribution; drug dose regimen; fluoxymesterone; methanol extraction residue
Journal Title: JAMA - Journal of the American Medical Association
Volume: 293
Issue: 9
ISSN: 0098-7484
Publisher: American Medical Association  
Date Published: 2005-03-02
Start Page: 1073
End Page: 1081
Language: English
DOI: 10.1001/jama.293.9.1073
PROVIDER: scopus
PUBMED: 15741529
Notes: --- - "Cited By (since 1996): 164" - "Export Date: 24 October 2012" - "CODEN: JAMAA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Clifford Hudis
    900 Hudis
  2. Larry Norton
    692 Norton