@article{3086693,
    title = "Safety and Tolerability of Anthracycline-Containing Adjuvant Chemotherapy in Elderly High-Risk Breast Cancer Patients",
    author = "Karavasilis, V. and Papadimitriou, C. and Gogas, H. and Kouvatseas, G. and Pentheroudakis, G. and Koutras, A. and Christodoulou, C. and Bafaloukos, D. and Samantas, E. and Pisanidis, N. and Papakostas, P. and Aravantinos, G. and Karanikiotis, C. and Kosmidis, P. and Pectasides, D. and Dimopoulos, M.-A. and Fountzilas, G.",
    journal = "Clinical Breast Cancer",
    year = "2016",
    volume = "16",
    number = "4",
    pages = "291-298.e3",
    publisher = "W B SAUNDERS CO-ELSEVIER INC",
    issn = "1526-8209, 1938-0666",
    doi = "10.1016/j.clbc.2015.12.001",
    keywords = "anastrozole;  anthracycline;  cyclophosphamide;  docetaxel;  epidermal growth factor receptor 2;  epirubicin;  exemestane;  fluorouracil;  gonadorelin derivative;  granulocyte colony stimulating factor;  hormone receptor;  methotrexate;  paclitaxel;  tamoxifen;  trastuzumab;  anthracycline;  antineoplastic agent;  antineoplastic antibiotic, adult;  aged;  anemia;  Article;  breast cancer;  cancer adjuvant therapy;  cancer combination chemotherapy;  cancer patient;  cancer survival;  cardiotoxicity;  cause of death;  chemotherapy induced emesis;  chemotherapy induced nausea and vomiting;  diarrhea;  disease free survival;  disease severity;  drug dose regimen;  drug safety;  drug tolerability;  drug withdrawal;  fatigue;  febrile neutropenia;  female;  follow up;  geriatric patient;  groups by age;  high risk patient;  human;  leukopenia;  loading drug dose;  lymph node metastasis;  major clinical study;  middle aged;  mucosa inflammation;  multiple cycle treatment;  nausea;  neutropenia;  overall survival;  partial mastectomy;  phase 3 clinical trial (topic);  randomized controlled trial (topic);  second cancer;  sensory neuropathy;  stomatitis;  thrombocytopenia;  treatment outcome;  vomiting;  adjuvant chemotherapy;  adverse effects;  age;  Breast Neoplasms;  chemically induced;  Chemotherapy-Induced Febrile Neutropenia;  comparative study;  dose response;  drug administration;  fatigue;  feasibility study;  Mucositis;  pathology;  Peripheral Nervous System Diseases;  risk assessment;  statistics and numerical data;  treatment withdrawal, Age Factors;  Aged;  Anthracyclines;  Antibiotics, Antineoplastic;  Antineoplastic Combined Chemotherapy Protocols;  Breast Neoplasms;  Chemotherapy, Adjuvant;  Chemotherapy-Induced Febrile Neutropenia;  Disease-Free Survival;  Dose-Response Relationship, Drug;  Drug Administration Schedule;  Fatigue;  Feasibility Studies;  Female;  Follow-Up Studies;  Humans;  Lymphatic Metastasis;  Middle Aged;  Mucositis;  Peripheral Nervous System Diseases;  Randomized Controlled Trials as Topic;  Risk Assessment;  Treatment Outcome;  Withholding Treatment",
    abstract = "We characterized the feasibility and toxicity profile of anthracycline-containing adjuvant chemotherapy in women >65 years of age with early breast cancer. Elderly breast cancer patients derive clinical benefit comparable with that of younger patients, mainly at the cost of increased risk of hematological toxicity. Background Intensive chemotherapy confers benefit to patients with high-risk early breast cancer (BC). We characterized the feasibility and toxicity profile of anthracycline-containing adjuvant chemotherapy (ACAC) in older women with early BC. Patients and Methods Available data from women who received ACAC for BC in 3 randomized trials were retrieved. We identified women aged >65 years and we examined differences in tolerability and delivery of chemotherapy, toxicity, and treatment outcome. Results From a total of 2640 patients, we identified 453 patients (17%) as being >65 years old, 89% of whom had tumors that were node-positive, with 77% who were hormone receptor-positive. At least 90% of the planned doses were delivered in 37% of the elderly, compared with 49% in the younger patients (P < .0001). Grade 3 and 4 hematological toxicity was observed in 32% of elderly patients, compared with 21% of the younger (P < .0001). Febrile neutropenia occurred in 4.5% of the elderly patients, as opposed to 2.0% in the younger patients (P < .002). Elderly patients experienced more frequent Grade 3 and 4 fatigue, mucositis, and sensory neuropathy. Relative dose intensities were significantly lower in elderly patients. Treatment discontinuation was not different in the 2 groups. At a median follow-up of 120 months, competing risks analysis showed a significant benefit in disease-free survival for elderly patients. Conclusion Elderly BC patients treated with ACAC derive clinical benefit comparable to that in younger patients, mainly at the cost of increased risk of hematological toxicity. This should be taken into account in decision-making and treatment individualization in high-risk BC patients. © 2015 Elsevier Inc."
}