Effect of Creatinine Clearance on Patterns of Toxicity in Older Patients Receiving Adjuvant Chemotherapy for Breast Cancer

Hurria, Arti; Hurria, A.; Brogan, Kelly; Panageas, Katherine S.; Pearce, Carol; Norton, Larry; Jakubowski, Ann A.; Howard, Jane; Hudis, Clifford A.

doi:10.2165/00002512-200522090-00007

Cited by 25 publications

(19 citation statements)

References 20 publications

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“…In previous studies, there has been an inverse association between creatinine clearance and occurrence of neutropenia during adjuvant chemotherapy for ESBC [29,30,31]. The reason why an impaired renal function matters with AC chemotherapy is probably that cyclophosphamide is excreted through the kidneys.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Objective: This retrospective study was undertaken to assess the incidence of and risk factors for febrile neutropenia (FN) during adjuvant chemotherapy for early-stage breast cancer (ESBC). Methods: A multicenter survey of three tertiary hospitals was conducted, with data extracted from the records of ESBC patients treated with adjuvant chemotherapy containing AC (doxorubicin, 60 mg/m² and cyclophosphamide, 600 mg/m² every 21 days). Assessments included clinical characteristics, chemotherapy dose modifications, and incidence of FN. Results: A total of 610 patients were included for analysis. The incidence of grade 4 neutropenia and FN was 44.6 and 8.5%, respectively. Reduced relative dose intensity (RDI) less than 85% occurred in 11.0% of patients, and there were treatment delays in 12.6% of patients. Multivariate analysis identified several independent predictors for FN, including the presence of grade 4 neutropenia and pretreatment calculated estimated glomerular filtration rate less than 60 ml/min. Conclusion: Patients with ESBC are at substantial risk for FN and reduced RDI when treated with adjuvant AC chemotherapy. Predictive models based on risk factors identified in this study should enable the selective application of supportive measures in an effort to deliver the full dose of chemotherapy.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Furthermore, a marked discrepancy between the CG and the MDRD formulae has been observed in a large population of over 65 years of age (20) and these formulae have been found to lack a consistent proportion of patients with renal failure within a population of octogenarian inpatients (21). Studies estimating renal function in solid cancer patients have previously been published (22)(23)(24)(25). However, the number of the cancer patients aged 80 years or older evaluated for renal function was limited (24,25).…”

Section: Discussionmentioning

confidence: 99%

Age-dependent decline in renal function in patients with lung cancer

et al. 2012

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Abstract. The aim of this study was to clarify the effect of aging on renal function. Serum creatinine (SCr), blood urea nitrogen (BUN) and 24-h creatinine clearance (measuredCrCl) were examined in lung cancer patients and the measured-CrCl were compared with CrCl estimates by employing two commonly used equations. In total, 787 lung cancer patients who were diagnosed between 2001 and 2010 were retrospectively analyzed. SCr and urine creatinine, BUN and measured-CrCl were evaluated prior to treatment. The Cockcroft-Gault (CG) and modification of diet in renal disease (MDRD) formulae were also used to estimate CrCl. SCr, BUN and measured-CrCl showed a significant decline in the elderly. In the 787 lung cancer patients, a significant correlation coefficient was found between measured-CrCl and age. However, in patients aged 80 years or older, no significant correlation coefficient was found between measured-CrCl and age. In the comparison between the measured CrCl and the CrCls estimated by the two formulae, the CG-CrCl levels were lower than those of the measured-CrCl, whereas the MDRDCrCl levels were higher. Age is a crucial factor influencing renal function in patients with lung cancer. Particularly in the elderly, a decline in CrCl and greater individual variability in CrCl, as well as discrepancies in measured-CrCl and estimated CrCls are significant factors.

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“…Creatinine clearance less than 50 mL/minute was found to be associated with an increased risk of febrile neutropenia or grade 3 or 4 hematological toxicity. By calculating creatinine clearance in elderly patients, which is a more accurate of measure of renal function than a serum creatinine level, the authors concluded that major toxicities could potentially be avoided by dose adjusting cytotoxic agents [54]. • Bone marrow reserve also declines with age.…”

Section: Toxicitymentioning

confidence: 99%

Adjuvant Chemotherapy for Early Breast Cancer in the Elderly

Leung

Shapira

Bradley

et al. 2009

Curr. Treat. Options in Oncol.

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The use of cytotoxic therapy in the fit elderly breast cancer patient has been tempered with concerns of age, physical function, and co-morbid illness. In the appropriate patient with biologically aggressive disease, such as receptor poor breast cancer, it is reasonable to consider combination chemotherapy as part of an adjuvant program. If this approach is to be employed, the physician must also consider the patient's co-morbid conditions and status of function in society as potential indicators of toxicity or lack of benefit. In this case, a formal geriatric assessment is of value. A Cancer and Leukemia Group B (CALGB) trial of monotherapy vs combination cytotoxic therapy as adjuvant treatment for localized breast cancer patients over 65 years of age has determined that the combination approach is superior to single agent therapy. In an unplanned analysis of receptor rich and receptor poor tumors, the patients with receptor poor tumors seemed to achieve the greatest benefit from combination cytotoxic therapy. Adjuvant chemotherapy can also be considered for patients with high-risk receptor rich breast cancers. However, the use of chemotherapy in the elderly patient with breast cancer is largely based upon data emerging from trials in younger patients. Studies specifically for patients over 65 years of age are urgently needed in this population to provide evidence-based proof of the current approach.

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Effect of Creatinine Clearance on Patterns of Toxicity in Older Patients Receiving Adjuvant Chemotherapy for Breast Cancer

Abstract: In this cohort of older breast cancer patients, a decreased CL(CR) and increased creatinine was associated with an increased risk of fever and neutropenia or haematological toxicity. CL(CR) should be considered when determining chemotherapy dosage in the elderly.

Cited by 25 publications

References 20 publications

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

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

Age-dependent decline in renal function in patients with lung cancer

Adjuvant Chemotherapy for Early Breast Cancer in the Elderly

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