1
|
Controversial issues in the management of older adults with early breast cancer. J Geriatr Oncol 2017; 8:397-402. [PMID: 28602710 DOI: 10.1016/j.jgo.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/05/2017] [Accepted: 05/24/2017] [Indexed: 12/12/2022]
Abstract
It is well recognized that the incidence of breast cancer increases significantly with age. Despite this, older people remain under-represented in many clinical trials and their management relies on extrapolation of data from younger patients. Providing an aggressive intervention can be challenging, particularly in less fit older patients where a conservative approach is commonly perceived to be more appropriate. The optimal management of this population is unknown and treatment decision should be personalized. This review article will discuss several controversial issues in managing older adults with early breast cancer in a multidisciplinary setting, including the role of surgical treatment of the axilla in clinically node negative disease, radiotherapy after breast conservation surgery in low-risk tumours, personalizing adjuvant systemic therapy, and geriatric assessments in breast cancer treatment decisions.
Collapse
|
2
|
Jain A, Linsell J, Briscoe K. Neutropenic fever rates with adjuvant docetaxel and cyclophosphamide in early breast cancer: audit from regional cancer centre in New South Wales. Intern Med J 2014; 44:1258-9. [PMID: 25442763 DOI: 10.1111/imj.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A Jain
- Department of Medical Oncology, North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | | | | |
Collapse
|
3
|
Lakhanpal R, Stuart-Harris R, Chan A, Kotasek D, Beith J, Cuff K, Bastick P, Lee C. Docetaxel and cyclophosphamide as adjuvant chemotherapy for early breast cancer: primary prophylaxis with G-CSF is required. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Aim: To determine the incidence of febrile neutropenia (FN) associated with the use of docetaxel and cyclophosphamide (TC) as adjuvant chemotherapy for early breast cancer (EBC) and also the grade of neutropenia after cycle 1 of TC. Methods: We conducted a multicenter retrospective audit of women with EBC treated with TC between January 2010 and July 2011, recruited from seven Australian centers. Results: Of a total of 368 previously untreated women with EBC who received TC, 300 were evaluable for FN and 304 were evaluable for neutropenia after cycle 1 of TC. Overall, 73 (24.3%) patients developed FN. The incidence of FN was highest after cycle 1 of TC and was significantly higher in women under 65 years of age (p = 0.007). There was significant variation in the incidence of FN between participating sites (p < 0.001). Eight patients (2.6%) developed grade 3 neutropenia and 191 patients (62.8%) developed grade 4 neutropenia. Conclusion: TC as adjuvant chemotherapy for EBC is associated with a 24.3% incidence of FN and a 65.4% incidence of grade 3 or 4 neutropenia. The high incidence of FN and severe neutropenia warrant the use of G-CSF as primary prophylaxis.
Collapse
Affiliation(s)
- Roopa Lakhanpal
- Medical Oncology Unit, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
| | - Robin Stuart-Harris
- Medical Oncology Unit, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
| | - Arlene Chan
- Breast Cancer Clinical Trials Unit, Mount Hospital, 146 Mounts Bay Road, Perth, WA 6000, Australia
| | - Dusan Kotasek
- Adelaide Cancer Center, Level 1, Tennyson Center, 520 South Road, Kurralta Park, SA 5037, Australia
| | - Jane Beith
- Medical Oncology Unit, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| | - Katharine Cuff
- Cancer Trials Unit, Level 2, Building 1, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Patricia Bastick
- Cancer Care Center, St George & Sutherland Hospitals, 1 Gray Street, Kogarah, NSW 2217, Australia
| | - Clara Lee
- Crown Princess Mary Cancer Care Center, Westmead Hospital, Westmead, NSW 2145, Australia
| |
Collapse
|