Toxicity of older and younger patients treated with adjuvant chemotherapy for node-positive breast cancer: The Cancer and Leukemia Group B experience
Toxicity of older and younger patients treated with adjuvant chemotherapy for node-positive breast cancer: The Cancer and Leukemia Group B experience
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DOI：
10.1200/jco.2007.10.9710
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发表时间：
2007-08-20
影响因子：
45.3
通讯作者：
Hudis, Clifford A.
中科院分区：
文献类型：
--
作者：
Muss, Hyman B.;Berry, Donald A.;Hudis, Clifford A.
目的：老年淋巴结阳性患者接受新的辅助化疗方案治疗后，无复发生存率和总生存率与年轻患者相似。我们比较了三个随机试验中的辅助化疗的毒性老年人和年轻人Patients and MethodsToxicity数据为93%的6,642例患者登记。这三项试验包括：癌症和白血病B组B（CALGB）8541，三种给药方案中环磷酰胺、阿霉素和氟尿嘧啶的比较; CALGB 9344：环磷酰胺和阿霉素联合或不联合紫杉醇;和CALGB 9741：每2周一次与每3周一次。国家癌症研究所3级至5毒性进行了比较，年龄groups.Results7%的患者（n = 458）年龄65岁或以上，3%为70岁或以上，38%为51至64，55%为50岁或以下。24例死亡（0.4%）归因于治疗; 486例65岁或以上患者中有7例（1.5%），2，480例51 - 64岁患者中有10例（0.40%），3，676例患者中有7例（0.19%）发生在50岁以下患者中。在多变量分析中，老年患者更可能发生4级血液学毒性，因毒性而停止治疗，或死于急性髓性白血病/骨髓增生异常综合征。有3级至4级nonhematologictoxic.Conclusionhealthy老年患者符合严格的资格标准，这些试验有较高的血液毒性和治疗相关的死亡率比年轻患者，但没有增加非血液毒性。接受新辅助化疗方案治疗的老年患者与年轻患者从新化疗方案中获得相同的获益，但应注意毒性和治疗相关死亡风险增加。
PurposeOlder node-positive patients treated with newer adjuvant chemotherapy regimens have improvements in relapse-free and overall survival similar to younger patients. We compared toxicity of older and younger patients in three randomized trials of adjuvant chemotherapy.Patients and MethodsToxicity data were available for 93% of 6,642 patients enrolled. The three trials included: Cancer and Leukemia Group B ( CALGB) 8541, a comparison of cyclophosphamide, doxorubicin, and fluorouracil in three dose schedules; CALGB 9344: cyclophosphamide and doxorubicin with or without paclitaxel; and CALGB 9741: cyclophosphamide, doxorubicin, and paclitaxel every 2 versus every 3 weeks. National Cancer Institute grade 3 to 5 toxicities were compared among age groups.ResultsSeven percent of patients ( n = 458) were age 65 or older, 3% were 70 or older, 38% were 51 to 64, and 55% were 50 or younger. Twenty-four deaths ( 0.4%) were attributed to treatment; seven ( 1.5%) of 486 in patients 65 or older, 10 ( 0.40%) of 2,480 in patients who were 51 to 64 years, and seven ( 0.19%) of 3,676 occurred in patients younger than 50. In multivariate analysis, older patients were significantly more likely to have grade 4 hematologic toxicity, to have discontinued treatment for toxicity, or to have died of acute myeloid leukemia/myelodysplastic syndrome. There were no significant differences in grade 3 to 4 nonhematologic toxicity.ConclusionHealthy 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.