Patterns of toxicity in older patients with breast cancer receiving adjuvant chemotherapy
Patterns of toxicity in older patients with breast cancer receiving adjuvant chemotherapy
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DOI：
10.1007/s10549-005-1410-8
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发表时间：
2005-07-01
影响因子：
3.8
通讯作者：
Hudis, C
中科院分区：
文献类型：
--
作者：
Hurria, A;Brogan, K;Hudis, C
目标。设计与方法我们对1998年1月至2000年12月间在斯隆-凯特林癌症纪念中心就诊的1405名65岁或以上的浸润性乳腺癌患者进行研究。从这组队列中选择进行分析的患者年龄在确诊时为65岁或以上；在纪念斯隆-凯特琳癌症中心接受过后续护理；患有I、II或III期乳腺癌；接受了由CMF(环磷酰胺、甲氨蝶呤和5-氟尿嘧啶)组成的辅助化疗，这是一种基于蒽环类药物的方案(AC[阿霉素和环磷酰胺]，或AC-T[AC和紫杉醇或多西紫杉醇])。排除标准包括既往化疗或既往乳腺癌。这项研究包括132名患者，平均年龄70岁(范围65-79岁)。Charlson共病指数评分低：0分(83%)、1分(12%)、2分(5%)；分期：I期(18%)、IIA期(41%)、IIB期(27%)、IIIA期(8%)、IIIB期(6%)、T1Nx期(1%)。接受以蒽环类药物为基础的方案的患者更有可能经历3级或4级毒性(p=0。需要住院(P<；0.001)，和/或出现发热性中性粒细胞减少症(P<；0.001)。在接受CMF治疗的患者中，由于骨髓抑制而导致的治疗延迟更频繁(p<；0.001)。化疗方案的类型(与CMF相比，使用蒽环类药物)比年龄增加或合并症评分更能预测毒性。在这组老年乳腺癌患者中，辅助化疗的毒性风险更多地取决于方案的类型(蒽环类药物与CMF)，而不是患者的实际年龄。
Objective. To retrospectively determine the relationship of age to toxicity from adjuvant chemotherapy for breast cancer.Design and Methods We identified 1405 consecutive patients age 65 or older with primary invasive breast cancer who were seen at Memorial Sloan-Kettering Cancer Center from January 1998 to December 2000. Patients selected from this cohort for analysis were aged 65 or older at diagnosis; received their follow-up care at Memorial Sloan-Kettering Cancer Center; had stage I, II, or III breast cancer; and received adjuvant chemotherapy consisting of CMF (cyclophosphamide, methotrexate, and 5-fluorouracil), an anthracycline-based regimen (AC [doxorubicin and cyclophosphamide], or AC-T [AC and paclitaxel or docetaxel]). Exclusion criteria included prior chemotherapy or previous breast cancer.Results. One hundred thirty-two patients were included in this study, with a mean age of 70 (range 65-79). Comorbidity measured by the Charlson comorbidity index was low: score 0 (83%), 1 (12%), 2 (5%); with stages: I(18%), IIA (41%), IIB (27%), IIIA (8%), IIIB (6%), T1Nx (1%). Patients receiving an anthracycline-based regimen were more likely to experience grade 3 or 4 toxicity (p=0. 01), require hospitalization (p < 0.001), and/or develop febrile neutropenia (p < 0.001). Treatment delays due to myelosuppression occurred more frequently in patients receiving CMF (p < 0.001). The type of chemotherapy regimen (anthracycline compared to CMF) was a better predictor for toxicity than increased age or comorbidity score.Conclusions. In this cohort of older patients with breast cancer, the risk for toxicity from adjuvant chemotherapy depended more on the type of regimen (anthracycline vs. CMF) than the patient's chronological age.