Maintaining Dose Intensity of Adjuvant Chemotherapy in Older Patients With Breast Cancer

Rahul Ladwa; Timothy Kalas; Shivanshan Pathmanathan; Natasha Woodward; David Wyld; Jasotha Sanmugarajah

doi:10.1016/j.clbc.2018.04.016

Maintaining Dose Intensity of Adjuvant Chemotherapy in Older Patients With Breast Cancer

Clin Breast Cancer. 2018 Oct;18(5):e1181-e1187. doi: 10.1016/j.clbc.2018.04.016. Epub 2018 Apr 28.

Authors

Rahul Ladwa¹, Timothy Kalas², Shivanshan Pathmanathan³, Natasha Woodward⁴, David Wyld⁵, Jasotha Sanmugarajah³

Affiliations

¹ Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. Electronic address: RL57@hotmail.co.uk.
² Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.
³ Department of Medical Oncology, Gold Coast University Hospital, Gold Coast, QLD, Australia.
⁴ Department of Medical Oncology, Mater Misericordiae Ltd/Mater Research Institute and the University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia.
⁵ Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Medical Oncology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.

PMID: 29778788
DOI: 10.1016/j.clbc.2018.04.016

Abstract

Introduction: Maintaining the relative dose intensity (RDI) of adjuvant chemotherapy at ≥ 85% has been associated with improved treatment outcomes in early-stage breast cancer (ESBC). Increasing evidence has suggested that patients aged ≥ 65 years can maintain the optimal RDI for standard chemotherapy regimens. The present study investigated the RDI of newer adjuvant chemotherapy regimens in this demographic.

Patients and methods: We retrospectively analyzed the data from 281 patients aged ≥ 65 years with a diagnosis of ESBC who had received adjuvant chemotherapy across 3 sites in Queensland, Australia from 2010 to 2015. The primary endpoint was the proportion of patients who had received an RDI of ≥ 85%.

Results: The median age at diagnosis was 68 years (range, 65-85 years), with 36.3% aged > 70 years. The patient characteristics included tumor stage T3 or T4 in 17% and node-positive disease in 60%. The common chemotherapy regimens included docetaxel/cyclophosphamide (23%), 5-fluorouracil/epirubicin/cyclophosphamide plus docetaxel or paclitaxel (17%); Adriamycin/cyclophosphamide/weekly paclitaxel (38%); and docetaxel/carboplatin/trastuzumab (11%). Primary (15%) and secondary (54%) granulocyte colony-stimulating factor (G-CSF) was used. An RDI of ≥ 85% was achieved in 63% of the patients. Significant associations were noted between a reduced RDI and age ≥ 70 years (P < .001), Charlson comorbidity index ≥ 1 (P = .043), initial dose reductions (P = .01), secondary G-CSF use (P = .45), hospital admission (P < .001), and febrile neutropenia (P = .007). Treatment-related toxicities were the most common reason for noncompletion, with high rates of hospital admissions (46%) and febrile neutropenia (22%).

Conclusion: Our findings suggest that patients aged ≥ 65 years with ESBC can maintain an optimal RDI with modern chemotherapy regimens. Appropriate geriatric assessment and the use of supportive measures such as G-CSF could better assist select groups to maintain an optimal dose intensity.

Keywords: Early breast cancer; Feasibility; Geriatric oncology; Relative dose intensity; Supportive measures.

MeSH terms

Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
Australia
Breast Neoplasms / drug therapy*
Chemotherapy, Adjuvant / methods*
Dose-Response Relationship, Drug
Female
Humans
Retrospective Studies