Side effects of standard adjuvant and neoadjuvant chemotherapy regimens according to age groups in primary breast cancer.
BACKGROUND
Elderly breast cancer patients are underrepresented in clinical trials and this leads to a lack of knowledge regarding the tolerance and side effects of modern chemotherapy regimens, especially in dose-dense (dd) or dose-intensified combination.


METHODS
In this analysis, data from 4 German, randomized (neo-)adjuvant trials, including anthracycline-based chemotherapy, were evaluated for toxicity, compliance and feasibility. Patients were grouped according to age.


RESULTS
Of the 4,775 patients, 73.6% were < 60 years, 15.8% were 60-64 years and 10.6% were > 64 years. The patients' compliance decreased with increasing age, the rate of therapy discontinuations was 10.3%; 16.0% were > 64 years old (p < 0.001). The rate of dose reductions also increased with increasing age in the docetaxel/doxorubicin/cyclophosphamide (TAC) (p overall = 0.02) and 5-fluorouracil/epirubicin-cyclophosphamide (FE120C) (p overall < 0.001) treatment groups. Neutropenia grade 3 + 4 in patients of > 64 years was 77% in FE120C- compared to 55% in TAC-treated patients (with primary granulocyte colony-stimulating factors (G-CSFs)). The incidence of febrile neutropenia (FN) was lowest in the regimens without additional taxanes. FN in patients aged > 64 years was lower in the FE120C- than in TAC-and dd-doxorubicin/docetaxel-treated groups.


CONCLUSIONS
The range and intensity of toxicity increased with age. Neutropenia did not increase significantly in the dd groups; the highest rate was seen in FE120C-treated patients. FE120C without G-CSFs is not an option in patients older than 64 years.
German Breast Group, Neu-Isenburg, Universitätsklinikum München, Klinikum Offenbach, Germany.
Mattea
M
Reinisch
German Breast Group, Neu-Isenburg, Universitätsklinikum München, Klinikum Offenbach, Germany.
Gunter
G
von Minckwitz
Frauenklinik, Universitätsklinikum München, Klinikum Offenbach, Germany.
Nadia
N
Harbeck
Frauenklinik, Universitätsklinikum Ulm, Klinikum Offenbach, Germany.
Wolfgang
W
Janni
Frauenklinik, Klinikum Essen Mitte, Essen, Universitätsklinikum Frankfurt/M., Klinikum Offenbach, Germany.
Sherko
S
Kümmel
Frauenklinik, Universitätsklinikum Frankfurt/M., Klinikum Offenbach, Germany.
Manfred
M
Kaufmann
Arbeitsgemeinschaft Gynäkologische Onkologie, Frauenklinik Sana Klinikum Berlin-Lichtenberg, Klinikum Offenbach, Germany.
Dirk
D
Elling
German Breast Group, Neu-Isenburg, Universitätsklinikum München, Klinikum Offenbach, Germany.
Valentina
V
Nekljudova
German Breast Group, Neu-Isenburg, Universitätsklinikum München, Klinikum Offenbach, Germany ; Brustzentrum, Klinikum Offenbach, Germany.
Sibylle
S
Loibl
Breast cancer; Chemotherapy; Elderly; Side effect; Tolerability