title: Predictors of chemotherapy dose reduction at first cycle in patients age 65 years and older with solid tumors.
abstract: OBJECTIVE
  Age-based reduction of chemotherapy dose with the first cycle (primary dose reduction, PDR) is not routinely guideline recommended. Few studies, however, have evaluated how frequently PDR is utilized in the treatment of older patients with cancer and which factors may be associated with this decision.
  
  
  METHODS
  We conducted a secondary analysis of a multi-institutional prospective cohort study of patients age ≥65 years treated with chemotherapy. The dose and regimen were at the discretion of the treating oncologist. The prevalence of PDR and its association with treatment intent (palliative vs. curative), tumor type, patient characteristics (sociodemographics and geriatric assessment variables), and chemotherapy-associated toxicity were evaluated.
  
  
  RESULTS
  Among 500 patients (mean age 73, range 65-91 years), 179 patients received curative intent chemotherapy and 321 patients received palliative intent chemotherapy, with PDR being more common in the latter sub-group (15% vs. 25%, p = 0.005). Increasing age was independently associated with PDR in both sub-groups. Comorbidity (prior cancer or liver/kidney disease) was independently associated with PDR in the palliative sub-group alone while Karnofsky Performance Status (KPS) was not associated with PDR in either subgroup. There was no significant difference in the rates of grades 3-5 toxicity, dose reductions, or delays with PDR. Patients in the palliative sub-group treated with PDR had higher rates of hospitalization compared to those treated with standard doses.
  
  
  CONCLUSIONS
  PDR is more common in the palliative setting, but is also utilized among patients treated with curative intent. Factors associated with PDR include age and comorbid conditions, but not KPS.
authors: Upstate Medical University and VA Medical Center, Syracuse, NY, USA. Electronic address: gajraa@upstate.edu.
authors: Ajeet
authors: A
authors: Gajra
authors: Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors: Heidi D
authors: HD
authors: Klepin
authors: City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors: Tao
authors: T
authors: Feng
authors: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: William P
authors: WP
authors: Tew
authors: University of Rochester, Rochester, NY, USA.
authors: Supriya G
authors: SG
authors: Mohile
authors: Case Western Reserve University, Cleveland, OH,USA.
authors: Cynthia
authors: C
authors: Owusu
authors: Cancer Outcomes, Public Policy, and Effective Research Center (COPPER), Yale School of Medicine, New Haven, CT, USA.
authors: Cary P
authors: CP
authors: Gross
authors: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Stuart M
authors: SM
authors: Lichtman
authors: Washington University School of Medicine, St Louis, MO, USA.
authors: Tanya M
authors: TM
authors: Wildes
authors: Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
authors: Andrew E
authors: AE
authors: Chapman
authors: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Efrat
authors: E
authors: Dotan
authors: City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors: Vani
authors: V
authors: Katheria
authors: City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors: Laura
authors: L
authors: Zavala
authors: City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors: Chie
authors: C
authors: Akiba
authors: City of Hope Comprehensive Cancer Center, Duarte, CA, USA. Electronic address: ahurria@coh.org.
authors: Arti
authors: A
authors: Hurria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy dose; Elderly; Geriatric assessment; Geriatric oncology