Sunday, May 17, 2009
Chemotherapy in Older Women with Early Breast Cancer
There aren't that many clinical studies that include older women with early breast cancer. Plus, older women are more likely to be treated with lower doses of chemotherapy than younger women. So, it becomes difficult to know how they should be treated if they present with early breast cancer.
Fortunately, the NEJM has an interesting article about the use of "Adjuvant Chemotherapy in Older Women with Early-Stage Breast Cancer." Here's the conclusion: Standard adjuvant chemotherapy is superior to capecitabine in patients with early-stage breast cancer who are 65 years of age or older. In this study, standard chemotherapy was either cyclophosphamide, methotrexate, and fluorouracil or cyclophosphamide plus doxorubicin. Capecitabine is marketed by Roche under the trade name Xeloda.
So what does all this mean? Here are some of the highlights from the discussion section of the article:
The authors note that "the choice of chemotherapeutic agents, dose, schedule, and dose modification should be based on the treatment plans in published reports." There are significant toxicities associated with certain chemotherapy agents and many older patients are unable to tolerate such regimens.
The authors also write that "patients in this trial had an excellent performance status and no major organ dysfunction. The toxicity of these regimens in vulnerable or frail patients is probably greater than the toxicity observed in the patients in this study, and they should be administered with caution or not at all in such patients."