Achieving Optimal Dose Intensity with Adjuvant Chemotherapy in Elderly Breast Cancer Patients: A 10-Year Retrospective Study in a UK Institution

Abstract

The study was to determine if breast cancer patients aged 65 and above could be given adjuvant chemotherapy safely while achieving an acceptable relative dose intensity of at least 85%. We identified all patients aged 65 and over who received adjuvant chemotherapy over the 10 year period, November 1999 to October 2009, and determined the proportion that achieved a relative dose intensity of at least 85% as well as the tolerability of their treatment. A total of 101 patients were identified, with a median age of 69 years (range 65-78).Of these, 25.7% of patients had at least one major comorbidity, 84.2% had a tumor size of 5 cm or less, 73.3% were node positive and 58.4% were hormone receptor positive. The chemotherapy regimens used were AC (Doxorubicin and Cyclophosphamide), FEC (Fluorouracil, Epirubicin, and Cyclophosphamide), CMF (Cyclophosphamide, Methotrexate, and Fluorouracil) and ECMF (Epirubicin followed by CMF). Seventy-nine patients (78.2%) achieved the relative dose intensity of at least 85%. With respect to toxicity, 11.9% of patients developed febrile neutropenia and 23.8% of patients required hospital admission during the treatment period, but there were no treatment-related deaths in the group. A significant proportion of patients aged 65 and above achieved the intended dose intensity of at least 85% over this 10-year period, with manageable toxicity levels. This supports the use of these regimens as adjuvant chemotherapy for breast cancer in this age group.

Maintaining Dose Intensity of Adjuvant Chemotherapy in Older Patients With Breast Cancer

“…deaths (see table 5). which 22% and 2% of patients, respectively, received FEC-D. 12,13 Another key difference is that several of these studies used considerably higher rates of primary prophylactic G-CSF in order to minimize rates of treatment-related febrile neutropenia and thus improve dose intensity. Although the present study failed to find an association between primary G-CSF use and RDI, it is important to note that the rate of primary G-CSF use among our cohort was too low to make firm conclusions.…”

“…5,[8][9][10] However, a growing body of evidence suggests that select older patients tolerate a range of adjuvant chemotherapy regimens better than previously thought and that they are capable of maintaining optimal dose intensity. [11][12][13][14] The primary aim of this study is to assess whether patients 65 years of age and older who received adjuvant chemotherapy for early stage breast cancer maintained an RDI of 85% and over.…”

OPTIMA prelim: a randomised feasibility study of personalised care in the treatment of women with early breast cancer

“…Rates of admission to hospital with serious complications have mostly been reported to be in the range 20% to 25% [5][6][7] and there is a small risk of early death from treatment, reported to be in the range 0.2% to 0.3% in recent studies. 8,9 Patients are frequently unable to work both during treatment and for some time thereafter, 10 which has considerable cost to society.…”

Incidence and Predictors of Febrile Neutropenia among Early-Stage Breast Cancer Patients Receiving Anthracycline-Based Chemotherapy in Korea

“…Clinical practice guidelines recommend the use of prophylactic granulocyte colony-stimulating growth factor (G-CSF) for FN in high-risk patients based on data from randomized clinical trials [15,16,17,18]. In addition, patient- and disease-specific factors should be considered in the appropriate use of G-CSF, such as age older than 65 years, previous chemotherapy or radiation therapy, poor performance status, preexisting neutropenia, or abnormal liver or renal function.…”