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Tolerance and Outcome

Nuhad K. Ibrahim, MD; Debra K. Frye, RN; Aman U. Buzdar, MD; Ronald S. Walters, MD; Gabriel N. Hortobagyi, MD

Arch Intern Med. 1996;156(8):882-888.

Abstract
Background
Metastatic breast cancer in elderly patients is less often treated with chemotherapy than in younger patients because of concerns related to toxic effects and tolerance. This is especially the case with doxorubicin-containing regimens.

Methods
We conducted a retrospective study of 1011 consecutive patients with metastatic breast cancer treated with doxorubicin-based chemotherapy protocols between July 1973 and July 1984. Age was not an exclusion criterion. Patient characteristics, dose intensity, hematologic-related toxic effects, and the cause of death were analyzed. The Kaplan-Meier survival curves were plotted and tested by the generalized Wilcoxon test.

Results
Seven hundred sixty-seven patients aged between 50 and 64 years were identified. While the response rate was higher in the younger group, the overall survival curves were similar for the two groups (P=.06), as well as the time to progression of the disease (P=.15). The dose intensity was comparabe between the groups (P=.49), as was the median platelet and white blood cell nadirs. Neutropenic fever occurred in 16% of each group (P=83), and fever in 12% and 17% of each group, respectively (P=.05). Death from infections occurred in 3.1% and 3.2% of patients in the two groups, respectively (P=.82).

Conclusion
Patients with metastatic breast carcinoma who are older than 65 years tolerate the acute side effects of doxorubicin-based combination chemotherapy as well as the younger age group. Time to progression of disease and the overall survival are similar for both groups. Doxorubicin-based regimens are safe and effective for patients older than 65 years.

(Arch Intern Med. 1996;156:882-888)

Author Affiliations
From the Department of Breast and Gynecologic Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex.

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