The importance of dose intensity in chemotherapy of metastatic breast cancer.

Hryniuk, William M.; Bush, Helen A.

doi:10.1200/jco.1984.2.11.1281

Cited by 826 publications

(257 citation statements)

References 32 publications

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“…The actual dose intensity (ADI) for each agent of the DA-POCH-R combination was calculated according to the method of Hryniuk and Bush. 22 Relative dose intensity (RDI) for each drug was defined as the ratio between the ADI delivered for each drug and the planned dose intensity of the first DA-POCH-R cycle. Hematologic and extrahematologic toxicities were scored according to the National Cancer Institute Common Toxicity Criteria (NCI-CTC), version 3.0.…”

Section: Evaluation Of Responsementioning

confidence: 99%

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

Musolino

Boggiani

Panebianco

et al. 2010

Cancer

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BACKGROUND: This study was designed to assess the activity and safety of dose-adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab (DA-POCH-R) in elderly patients with poor-prognostic untreated diffuse large B-cell non-Hodgkin lymphoma (DLBCL). METHODS: From April 2006 to November 2009, 23 patients, aged !70 years, with an age-adjusted International Prognostic Index (IPI) of 2 or 3, were enrolled. Only patients with left ventricular ejection fraction (LVEF) !50% were allowed. The DA-POCH-R regimen was administered every 3 weeks for a minimum of 6 and a maximum of 8 cycles. RESULTS: Median patient age was 77 years (range, 70-90 years); 83% of patients had Ann Arbor stage III to IV disease. Median LVEF at baseline was 62%. Four (17%) patients had a history of abnormal cardiovascular conditions. Twenty-one (91%) patients were evaluable for response. The overall response rate was 90%, with a complete response rate of 57%. The 3-year overall survival and event-free survival rates were 56% and 54%, respectively. Neutropenia (48%) was the most frequent grade 3 to 4 adverse event (AE); no grade 3 to 4 cardiac AEs were observed. CONCLUSIONS: DA-POCH-R was an active and safe combination therapy for patients aged !70 years with poor-prognostic untreated DLBCL. This regimen was a reasonable alternative for elderly patients who were not considered to tolerate standard R-CHOP treatment. Cancer 2011;117:964-73.

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Section: Evaluation Of Responsementioning

confidence: 99%

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

Musolino

Boggiani

Panebianco

et al. 2010

Cancer

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“…If the patient's chart did not contain an explicit reference to planned amounts, the actual dose administered for Cycle 1 was used to infer the planned dose. The planned average relative dose intensity (ARDI) 14 for each patient was obtained by averaging the RDIs of cyclophosphamide and doxorubicin for the CHOP and CHOP plus rituximab therapies and by averaging the RDIs of cyclophosphamide and mitoxantrone for CNOP therapy. ARDI was dichotomized as greater than or equal to 80% or less than 80%.…”

Section: Treatment Characteristics and Outcomesmentioning

confidence: 99%

Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP‐R, or CNOP chemotherapy for intermediate‐grade non‐Hodgkin lymphoma

Lyman

Delgado

2003

Cancer

169

111

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BACKGROUNDHospitalization for chemotherapy‐induced febrile neutropenia is associated with substantial cost and may negatively impact clinical outcome due to associated dose attenuation.METHODSMedical records of 1355 patients with intermediate‐grade non‐Hodgkin lymphoma receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or similar chemotherapy were reviewed. The potential risk factors associated with first hospitalization for febrile neutropenia were evaluated.RESULTSIn the current study, 230 patients (17%) experienced 1 or more hospitalizations for febrile neutropenia and greater than one‐half of all initial hospitalizations for febrile neutropenia occurred in Cycles 1 or 2. Increased risk of hospitalization for febrile neutropenia, based on Cox proportional hazards models, was significantly associated with the following characteristics: age 65 years or older (hazard ratio [HR] = 1.79; 95% confidence interval [95% CI], 1.35–2.37), serum albumin level at presentation less than or equal to 3.5 g/dL (HR = 1.34; 95% CI, 1.01–1.78), planned average relative dose intensity greater than or equal to 80% (HR = 2.70; 95% CI, 1.47–4.98), baseline absolute neutrophil count less than 1500/mm3 (HR = 1.98; 95% CI, 1.28–3.06), and the presence of hepatic disease (HR = 2.18; 95% CI, 1.11–4.28). Lack of early granulocyte colony‐stimulating factor in Cycles 1 and 2 was also associated with increased risk of hospitalization for febrile neutropenia, but this did not reach statistical significance. A composite risk score based on these potential risk factors effectively distinguished patients at greater risk of hospitalization for febrile neutropenia (P < 0.001), the majority of which were observed during the first cycle of chemotherapy.CONCLUSIONSThe data from the current study demonstrated that the risk of initial hospitalization for febrile neutropenia occured early in the course of CHOP‐like chemotherapy. Identified risk factors for febrile neutropenia hospitalization may facilitate the use of targeted supportive care. Cancer 2003. © 2003 American Cancer Society.

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“…cyclophosphamide and doxorubicin, decreased because of the concomitant use of other drugs (Fisher et al, 1993). Dose intensity is defined as the amount of drug administered per unit of time (usually expressed as mg m-2 week-'); it was extensively studied in the 1980s by Hryniuk and his group (Hryniuk, 1984). A retrospective analysis on the association between projected dose intensity of British Journal of Cancer (1998) 78(6), [777][778][779][780] .…”

Section: Discussionmentioning

confidence: 99%

“…The dose intensity, expressed in milligrams per square metre of body surface area per week, was calculated for each drug by dividing the total amount of drug (planned or received) by the duration of chemotherapy (Hryniuk, 1984). The ratio between the actually received dose intensity and the planned dose intensity was the same for each drug, as no differential reductions in dose or delays in time of administration were foreseen or applied.…”

Section: Methodsmentioning

confidence: 99%

High-dose intensity cyclophosphamide, epidoxorubicin, vincristine and prednisone by shortened intervals and granulocyte colony-stimulating factor in non-Hodgkin's lymphoma: a phase II study

Pronzato¹,

Lionetto²,

Botto³

et al. 1998

Br J Cancer

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Summary Twenty patients with non-Hodgkin's lymphoma were treated with a combination of cyclophosphamide (750 mg m-2, day 1), epidoxorubicin (60 mg m-2, day 1), vincristine (1.4 mg m-2, day 1) and prednisone (100 mg m-2, days 1-5) every 14 days. Shortening of intervals was associated with the prophylactic employment of granulocyte colony-stimulating factor (G-CSF; specifically, filgrastim) administered at a dose of 300 gg subcutaneously from day 6 to day 11. The ratio between actually delivered dose intensity and planned dose intensity was 1.0 in 18 out the 20 patients. Toxicity was acceptable; response rate and survival are in the expected range. The present study demonstrated the feasibility of acceleration of chemotherapy cycles to obtain dose intensification in non-Hodgkin's lymphoma.

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The importance of dose intensity in chemotherapy of metastatic breast cancer.

Cited by 826 publications

References 32 publications

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP‐R, or CNOP chemotherapy for intermediate‐grade non‐Hodgkin lymphoma

High-dose intensity cyclophosphamide, epidoxorubicin, vincristine and prednisone by shortened intervals and granulocyte colony-stimulating factor in non-Hodgkin's lymphoma: a phase II study

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