Breast cancer incidence increases w...

Breast cancer incidence increases with age. The use of systemic adjuvant chemotherapy to treat early-stage breast cancer has been shown to improve overall and relapse-free survival in women 50 to 69 years of age, nevertheless it is not known whether older women receive the same benefit. Because of increased risk of toxic events adjuvant chemotherapy may be underused in older patients. Muss and colleagues, for the Cancer and Leukemia cluster B (CALGB), reported on the retrospective review of four trials comparing les aggressive with more aggressive chemotherapy to determine the weights of dose-intensive regimens on older patients.

The four CALGB trials (7581 8082 8541 and 9344) compared various dosage regimens in patients with node-positive breast cancer. In the 7581 trial, cyclophosphamide (Cytoxan), methotrexate (Trexall), and fluorouracil (Efudex) plus vincristine (Oncovin) and prednisone improved disease-free survival if it be not that not overall survival compared with cyclophosphamide, methotrexate, and fluorouracil alone or cyclophosphamide, methotrexate, and f luorouracil plus methanol extraction residue of bacillus Calmette-Guerin.

In trial 8082 sum of two units cyclophosphamide, methotrexate, and fluorouracil regimens were base to be equivalent, but when a follow-up regimen based onward doxorubicin (Adriamycin) was added to undivided arm, it was associated with improved disease-free and overall survival.

In the 8541 trial, three dosage and duration ranges of cyclophosphamide, doxorubicin, and fluorouracil erect that moderate- and high-dosage clumps had longer disease-free and overall survival. A subset of patients with human epidermal pullulation factor 2 tumors in the high-dosage form into groupss had significantly better disease-free and overall survival.

The 9344 trial originate no differences among groups randomized to three doses of doxorubicin combined with cyclophosphamide, however patients subsequently randomized to receive additional paclitaxel (Taxol) had improved five-year disease-free and overall survival.

These four trials exhibit a span of 24 years and 6487 patients. Tumor sizes did not differ significantly among age form into groupss but the number of positive nodes increased with age. Overall treatment-related mortality was 05 percent with chemotherapy-related mortality increasing linearly with age. Age was unrelated to disease-free or overall survival. Predictors of shortened survival included higher number of positive nodes, larger tumor size, no tamoxifen (Nolvadex) use, and estrogen receptor-negative tumors. More chemotherapy improved overall survival compared with les chemotherapy, regardless of age.

The authors terminate that older patients who receive more chemotherapy do as well as younger patients, however their risk of recurrence is higher because of the greater number of positive lymph nodes in this assign places to Only 8 percent of the women chronicleed in the CALGB trials were older than 65 years, which may be because of an age bias in succession the part of physicians when offering participation in clinical trials. The authors caution that participation in of recent origin trials should be limited to women in otherwise suitable health.

CAROLINE WELLBERY, MD Muss HB et al. Adjuvant chemotherapy in older and younger women with lymph-node positive breast cancer. JAMA March 2 2005;293:1073-81

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2006 Gale Group