Toxicity of Older and Younger Patients Treated With Adjuvant Chemotherapy for Node-Positive Breast Cancer: The Cancer and Leukemia Group B Experience

Abstract

Healthy older patients who met the strict eligibility criteria for these trials had a higher rate of hematologic toxicity and treatment-related deaths than younger patients, but no increase in nonhematologic toxicity. Elderly patients treated with newer adjuvant chemotherapy regimens derive the same benefits from newer chemotherapy regimens as younger patients but should be cautioned about the increased risk of toxicity and treatment-related death.

Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy

“…This was perhaps expected, as elderly patients have previously been reported to be at increased risk of chemotherapy-related haemotoxicity compared with younger patients [13][14][15]. For example, in a multivariate analysis of 6642 patients receiving adjuvant chemotherapy for breast cancer, older patients were significantly more likely to have grade 4 haematological toxicity, to discontinue treatment for toxicity, or to die of acute myeloid leukaemia or myelodysplastic syndrome [13].…”

“…Older patients with breast cancer may be substantially more likely to experience haematological toxicity compared with younger individuals [13][14][15], but they derive the same proportional benefits from more intensive chemotherapy [16]. The EORTC [17] and German oncology association [18] have issued guidelines relating specifically to the use of G-CSF in elderly patients, noting that G-CSF can reduce the incidence of chemotherapy-induced neutropenia in this population.…”

Recommendations for research priorities in breast cancer by the Coalition of Cancer Cooperative Groups Scientific Leadership Council: systemic therapy and therapeutic individualization

“…In addition, there is concern about the long-term adverse effects of chemotherapy, including preservation of fertility in young women [149], acute leukemia [150][151][152][153], cardiac dysfunction after anthracyclines and/or irradiation [154,155], peripheral neuropathy after taxanes [156], and cognitive dysfunction [157]. Limitations of research into cognitive dysfunction have included a lack of consistency in defining cognitive impairment, the neuropsychiatric batteries used, the sensitivity of the measures to mild impairment, and the preponderance of cross-sectional and dearth of more informative longitudinal studies [157].…”

“…Older women have been generally underrepresented in CTs [160][161][162]. Older individuals who participated in trials tended to have higher risk disease and fewer comorbidities, had more adverse effects from adjuvant chemotherapy than younger women, but experienced comparable benefits [151]. Table 6 Research recommendations and high priority studies in quality of life…”

Muscle depletion and the prediction of chemotherapy toxicity

“…Up to 30 % of patients treated with 5-fluorouracil (5-FU)/capecitabine experience dose-limiting toxicities including diarrhea, handfoot syndrome, mucositis and myelosuppression [8]. Toxicity frequently implies reduction or interruption of anticancer therapy and may lead to fatal complications, particularly in older persons [3,9]. Besides its detrimental role in negatively affecting prognosis and survival of cancer patients, toxicity to chemotherapy negatively impacts on the financial burden of cancer, causing increase in both direct medical costs and indirect mortality costs [10] An American pilot study [11] evaluating the total costs of chemotherapy-induced toxicity in ovarian cancer patients in 2001 estimates that the cost for every single episode of neutropenia is USD $ 7,546.…”