Optimal delivery of anthracycline-based chemotherapy in the adjuvant setting improves outcome of breast cancer patients

Abstract

To evaluate the dose-response effect of an adjuvant anthracycline-based non-taxane chemotherapy in early breast cancer patients. This was a retrospective database analysis. Selection criteria included patients treated for early breast cancer from years 1980 to 2000 with an adjuvant anthracycline-based non-taxane chemotherapy. The delivery of chemotherapy was assessed through the number of delayed cycles, the number of delayed days and the relative dose intensity (RDI) administered (C85%, \85%). Seven hundred and ninety-three breast cancer patients were included. The Kaplan-Meier disease-free survival (DFS) was affected by the number of delayed cycles (P \ 0.0001), the number of delayed days (P \ 0.0001) and the RDI (P = 0.0029). The KaplanMeier overall survival (OS) was also affected by the number of delayed cycles (P = 0.0008) and days (P = 0.0115), as well as the RDI (P = 0.0055). The Cox regression models showed that, when the number of nodes affected and the hormonal receptor status were controlled, all the study variables maintained their significance on DFS, but not on OS. The dose-response effect is a crucial factor in the administration of anthracycline-based nontaxane schedules for the adjuvant treatment of early breast cancer. Delays and/or reductions of chemotherapy should be avoided if possible to achieve the maximal benefit.

Chemotherapy treatment patterns and neutropenia management in gastric cancer

“…FN can be life-threatening, with up to 9.5 % in-hospital mortality reported [11]. FN can lead to reduced chemotherapy dose delivery and subsequently, reduced chemotherapy efficacy [12][13][14]. Guidelines recommend use of G-CSF primary prophylaxis in patients with C 20 % risk of FN based on chemotherapy regimen and individual patient characteristics, while secondary prophylaxis is recommended in the subsequent cycle after an FN event [15,16].…”

PharmaForum

“…lativen Dosisintensität mit einer Verschlechterung des Gesamtüberlebens einhergeht, mahnte Untch [6]. Indiziert ist die Primärprophylaxe mit einem G-CSF laut AGO-Empfehlungen bei einem zu erwartenden FN-Risiko >20%, wie es bei einer dosisdichten Chemotherapie regelhaft der Fall ist [7].…”

Dose modifications in adjuvant chemotherapy for solid organ malignancies: A systematic review of clinical trials

“…In the adjuvant setting higher dose intensity is associated with better overall survival (OS) and disease-free survival (DFS) in breast cancer. 13,14 However, although treatment-related mortality is low in the adjuvant setting, 15,16 many oncologists will have seen their patients endure significant and occasionally life-threatening toxicity. Therefore, the recommendations of the NSW Department of Health acknowledged that medical oncologists may modify these treatment protocols where clinically appropriate.…”