Delivering adjuvant chemotherapy to women with early-stage breast carcinoma

Link, Brian K.; Budd, G. Thomas; Scott, Shelley A.; Dickman, Elliot; Paul, D. M.; Lawless, Grant; Lee, Martin; Fridman, Moshe; Ford, Jon M.; Carter, William B.

doi:10.1002/1097-0142(20010915)92:6<1354::aid-cncr1458>3.0.co;2-p

Cited by 82 publications

(48 citation statements)

References 29 publications

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“…A similar analysis of records from over 4,500 patients with NHL found substantial reductions in chemotherapy dose intensity in half of the patients [23]. Other retrospective analyses have also concluded that a sizeable proportion of patients undergoing treatment in a variety of practice settings receive less than optimal chemotherapy [24,25]. Reductions in dose intensity can occur from the outset, when physicians decide that patients cannot tolerate full doses for reasons such as age or comorbidity, or they can occur in response to side effects resulting from the chemotherapy administration itself.…”

Section: Discussionmentioning

confidence: 93%

Neutropenic Events in Community Practices Reduced by First and Subsequent Cycle Pegfilgrastim Use

Ozer

Mirtsching²,

Rader

et al. 2007

The Oncologist

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LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the incidence of neutropenia-related endpoints when pegfilgrastim was administered in the first and subsequent chemotherapy cycles.2. Compare results with data reflecting current practice standards.3. Discuss the relevance of pegfilgrastim use beginning in the first cycle of chemotherapy.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTThe impact of first-and subsequent-cycle growth factor use in the community setting has not been studied extensively. We conducted this large, prospective, noncomparative study to assess neutropenia and related complications in patients receiving myelotoxic chemotherapy with pegfilgrastim support in community practices. Patients >18 years old with cancers other than leukemia or myelodysplastic syndrome, including those with major comorbidities, were eligible. Pegfilgrastim (6 mg) was to be administered ϳ24 hours after chemotherapy in all cycles (minimum, four cycles). A total of 2,112 patients was included in the analyses. The most common tumor types were breast cancer (46%), nonHodgkin's lymphoma (15%), and non-small cell lung cancer (13%). Chemotherapies administered most often were a platinum plus a taxane (18%), and anthracycline plus an alkylating agent (18%), and a taxane plus an anthracycline plus an alkylating agent (16%). The percentage of patients with neutropenia-related hospitalization was 2.9% in cycle 1 and 5.6% across all cycles. Chemotherapy dose reductions and delays were attributed to neutropenia in 1.8% and 0.9% of patients, respectively, in cycle 2 and 2.9% and 2.1% of patients, respectively, across all cycles. Febrile neutropenia (absolute neutrophil count <1.0 ؋ 10 9 /l with temperature >38.2°C) occurred in 3.6% of patients in cycle 1 and in 6.3% of patients across all cycles. The most frequently reported serious adverse events were febrile neutropenia (3.4%), neutropenia (2.6%), and dehydration (2.6%). Bone pain (0.1%)

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Section: Discussionmentioning

confidence: 93%

Neutropenic Events in Community Practices Reduced by First and Subsequent Cycle Pegfilgrastim Use

Ozer

Mirtsching²,

Rader

et al. 2007

The Oncologist

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“…Growth factor support in DD chemotherapy regimens can reduce the incidence of neutropenic complications, thereby facilitating the administration of a high percentage of chemotherapy doses as planned (Bonadonna, 1996). Because delivery of planned doses of chemotherapy is associated with improved survival, DD regimens often include growth factor support (Bonadonna, 1996;Link et al, 2001;Citron et al, 2003;Möbus et al, 2004).…”

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confidence: 99%

Randomised trial: survival benefit and safety of adjuvant dose-dense chemotherapy for node-positive breast cancer

Kümmel

Krocker

Kohls³

et al. 2006

Br J Cancer

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We evaluated the survival benefit, safety, feasibility, and tolerability of dose-dense (DD) adjuvant chemotherapy with epirubicin and paclitaxel for women with node-positive primary breast cancer. Randomised patients (n ¼ 216) received DD or conventionalschedule (CS) chemotherapy. Dose-dense regimen patients (n ¼ 108) received epirubicin 90 mg m À2 plus paclitaxel 175 mg m À2 in four 14-day cycles, then cyclophosphamide 600 mg m À2 , methotrexate 40 mg m À2 , and fluorouracil 600 mg m À2 (CMF 600/40/600) in three 14-day cycles, plus filgrastim 5 mg kg day À1 as growth support in every cycle. Conventional-schedule regimen patients (n ¼ 108) received epirubicin 90 mg m À2 plus cyclophosphamide 600 mg m À2 in four 21-day cycles, then CMF 600/40/600 in three 21-day cycles, plus filgrastim if required. After a median follow-up of 38.4 months, 71 patients (33%) relapsed or died: DD, 33 patients (15 deaths); CS, 38 patients (22 deaths). Dose dense showed a trend for improved disease-free survival (DFS) and overall survival (OS). Four-year rates of DFS and OS were 64 and 85% for DD, and 58 and 75% for CS. All seven cycles were administered to 208 patients (96%). Rates of cycle delay, discontinuation, dose reduction, and adverse events were similar in both groups. Dose-dense sequential chemotherapy with epirubicin/paclitaxel then CMF, supported by filgrastim, is safe and improves survival for patients with node-positive breast cancer.

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“…Additionally, prospective studies demonstrated that an increase in chemotherapy RDI resulted in an improvement of DFS and OS (Budman et al, 1998;Citron et al, 2003;Bonneterre et al, 2005). In spite of these clear data, several retrospective analyses evaluating adjuvant chemotherapy RDI in daily practices have shown a significant decrease in RDI, irrespective of country and chemotherapy regimen (Link et al, 2001;Morrow et al, 2002;Ottevanger et al, 2002;Leonard et al, 2003;Lyman et al, 2003;Schaapveld et al, 2004;Chirivella et al, 2006;Shayne et al, 2006). Among these analyses, 20-30% of patients received less than 85% of pre-planned chemotherapy schedule.…”

Section: Discussionmentioning

confidence: 99%

“…The comparison between these two randomised trials highlights that changes in treatment modalities lead to a 12% increase of RDI, whereas the use of G-CSF is multiplied by 35 Roche et al, 2006). One of the major reasons identified for a reduction in chemotherapy doses was neutropaenia (Silber et al, 1998;Link et al, 2001). Indeed, chemo-induced neutropaenia are often controlled by dose reductions, or cycle delays, which may compromise the disease outcome.…”

Section: Discussionmentioning

confidence: 99%

Does chemotherapy-induced neutropaenia result in a postponement of adjuvant or neoadjuvant regimens in breast cancer patients? Results of a retrospective analysis

et al. 2007

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In 2005, 224 patients received adjuvant/neoadjuvant chemotherapy for breast cancer in a single institution according to daily practices. Regimens consisted of epirubicin-based chemotherapy (FEC100, four or six cycles), or three cycles of FEC100 followed by three cycles of docetaxel. An absolute blood count was carried out every 3 weeks, 1 -3 days before planned chemotherapy cycle. Overall, 1238 cycles were delivered. An absolute neutrophil count (ANC) o1.5 Â 10 9 l À1 before planned chemotherapy was found in 171 cycles. Of these, 130 cycles (76%) were delivered as planned regardless of whether ANC levels recovered, and 41 (24%) were delayed. None of these patients developed a febrile neutropaenia. Haematopoietic support (granulocyte colony-stimulating factor (G-CSF)) was required in 12 cycles. We found that the majority of patients with an ANC o1.5 Â 10 9 l À1 before planned chemotherapy received planned doses, without complications and need for G-CSF.

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Delivering adjuvant chemotherapy to women with early-stage breast carcinoma

Cited by 82 publications

References 29 publications

Neutropenic Events in Community Practices Reduced by First and Subsequent Cycle Pegfilgrastim Use

Neutropenic Events in Community Practices Reduced by First and Subsequent Cycle Pegfilgrastim Use

Randomised trial: survival benefit and safety of adjuvant dose-dense chemotherapy for node-positive breast cancer

Does chemotherapy-induced neutropaenia result in a postponement of adjuvant or neoadjuvant regimens in breast cancer patients? Results of a retrospective analysis

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