Doxorubicin-Based Chemotherapy in Elderly Patients With Metastatic Breast Cancer

Ibrahim, Nuhad K.

doi:10.1001/archinte.1996.00440080078009

Cited by 62 publications

(1 citation statement)

References 3 publications

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“…In one study from the French Adjuvant Study Group, adjuvant chemotherapy with a single‐agent anthracycline drug in patients aged 65 and older showed no significant improvement in disease‐free or overall survival 171 . In a retrospective study, anthracycline‐based chemotherapy showed similar improvements in disease‐free and overall survival in patients aged 65 and older as in patients aged 50 to 65 172 . A retrospective analysis showed that older women who received adjuvant chemotherapy benefited from a similar reduction in breast cancer mortality and recurrence 173 .…”

Section: Resultsmentioning

confidence: 99%

Quality Indicators for the Care of Breast Cancer in Vulnerable Elders

Naeim

Sawhney

MacLean

et al. 2007

J American Geriatrics Society

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B reast cancer is the most common cancer diagnosed in women 1,2 and the second highest cause of cancer mortality in the United States. 3,4 Although approximately half of the women diagnosed with breast cancer are older than 65, 5 older patients are frequently underrepresented in oncology clinical trials. 6-8 Consequently, the risks and benefits of treatments is not well understood in older women. Some studies suggest that elderly patients with breast cancer are undertreated and thus have higher mortality then their younger counterparts. 9 This monograph discusses the relationship between processes and outcomes of care for breast cancer, identifies potential quality indicators (QIs) that may be used to assess the treatment of vulnerable elders (VEs) with breast cancer, and reviews the available evidence in support of these indicators. METHODSA total of 1,294 articles were considered in this review: 38 were identified using a Web search and 1,256 through Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches. One limitation in developing this QI set was that, for some topics, previous studies and analyses had limited data on older patients. An effort was made to denote data specific to an older population within the text when they were available and relevant. RESULTSOf the 24 potential QIs, 21 were judged valid using the expert panel process (see the QIs on pages S464-S487 of this supplement), three were rejected, and two were added, for a total of 23 in the final set. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.Mammogram 1. IF a female VE is younger than age 70, THEN she should be offered mammographic screening for breast cancer every 2 years, BECAUSE mammography decreases breast cancer mortality. Supporting EvidenceThree meta-analyses reported a statistically significant reduction in risk of death from breast cancer in women who received screening mammography (relative risk (RR) 5 0.70, 0.71, and 0.74). 10-12 Two randomized, controlled trials (RCTs) of screening mammography 13,14 reported statistically significant reductions in the risk of death due to breast cancer in women younger than 70 but not in women aged 70 and older, whereas two case-control studies provided inconclusive evidence as to whether mammography reduced breast cancer mortality in women aged 65 and older. 15,16 Finally, a retrospective analysis demonstrated that women aged 65 to 74 benefited from screening mammography, 17 and a retrospective cohort study using population data from the National Cancer Institute (NCI)'s Surveillance, Epidemiology, and End Results (SEER) program demonstrated that women aged 67 and older who did not receive mammography were more likely to be diagnosed with breast cancer Stage II or greater and also more likely to die from breast cancer than women of the same age range who were regular users of mammography. 18 An evidence-based review of the literature by the U.S. Preventive Services Task Force (USPSTF) in 1996 recommended the us...

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Section: Resultsmentioning

confidence: 99%

Quality Indicators for the Care of Breast Cancer in Vulnerable Elders

Naeim

Sawhney

MacLean

et al. 2007

J American Geriatrics Society

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Oral doxifluridine plus levoleucovorin in elderly patients with advanced breast cancer

Bajetta

Biganzoli

Carnaghi

et al. 1998

Cancer

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BACKGROUND There currently is no agreement regarding the appropriate treatment of elderly patients with advanced breast carcinoma (ABC). Doxifluridine (5‐dFUR), a prodrug of 5‐fluorouracil, has been found to be effective in this entity, but its use is limited by neurotoxicity and cardiotoxicity that are not observed when the oral formulation is used. The objective of this Phase II trial was to evaluate the effectiveness and tolerability of oral 5‐dFUR, biomodulated with levoleucovorin (l‐leucovorin), in elderly patients (age > 70 years) with ABC. METHODS 5‐dFUR was administered orally at 600 mg/m2 twice daily for 4 consecutive days every 12 days, and oral l‐leucovorin was administered as 25 mg 2 hours before each 5‐dFUR administration. Response was assessed every five cycles according to the World Health Organization criteria. In the presence of response or stable disease, the patients were treated for a maximum of 15 cycles. RESULTS Seventy‐three eligible patients were enrolled, 27 of whom had been pretreated with chemotherapy and/or hormonotherapy; all were assessable for response and toxicity after a median follow‐up of 15 months. The objective response rate was 26% (95% confidence interval, 17.4‐45.4). Regression predominantly occurred in the presence of soft tissue involvement (skin, lymph nodes, and breast). The median time to response was 2 months (range, 1‐2 months) and the median response duration was 7 months (range, 2‐17+ months). The median survival was 24 months (range, 2‐42+ months). The treatment was very well tolerated, and the side effects were manageable and always reversible. CONCLUSIONS The results of the current study show that 5‐dFUR plus l‐leucovorin, both given orally, are associated with excellent patient compliance. Although the results are suboptimal in terms of an objective response, this characteristic could allow 5‐dFUR to be used in elderly patients considered unsuitable for "aggressive" chemotherapy. Cancer 1998;83:1136‐1141. © 1998 American Cancer Society.

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Chemotherapy in Older Adults with Cancer

Aapro

Wildiers

2012

Cancer and Aging Handbook

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Doxorubicin-Based Chemotherapy in Elderly Patients With Metastatic Breast Cancer

Cited by 62 publications

References 3 publications

Quality Indicators for the Care of Breast Cancer in Vulnerable Elders

Quality Indicators for the Care of Breast Cancer in Vulnerable Elders

Oral doxifluridine plus levoleucovorin in elderly patients with advanced breast cancer

Chemotherapy in Older Adults with Cancer

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