Older Patients May Still Tolerate Full Dose Chemotherapy

One of the concern oncologists have when treating “older” patients ages 70 or above is whether these patients may tolerate the full range of side effects that accompany dose intensive chemotherapy, and some oncologists are more conservative when treating the elderly patient population. In a recent study published in the Cancer medical journal, Dr. Michelle Shayne and colleagues looked at 115 community oncology practices and 976 patients who had received chemotherapy between 2002 and 2005 for various types of cancers and tumors to look at how elderly patients experience side effects from the dosage of chemotherapy they received.

The side effects in particular included severe neutropenia (abnormal decrease in the number of neutrophils in the blood) and febrile neutropenia (reduced white blood cells used to fight an infection). The researchers found that older patients tend to receive lower dose chemotherapy even though patients who received 85% or more of the relative dose intensity of chemotherapy did not show significant increase in neutropenia side effects. Thus this would suggest that older patients may tolerate the high dose chemotherapy they would need to improve their chances of fighting cancer, and oncologists should take this study into consideration when designing the cancer fighting regimen for an older patient.

Original Article
Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy
Michelle Shayne, MD 1, Eva Culakova, PhD 1, Marek S. Poniewierski, MD, MS 1, Debra Wolff, MS, PCNP 1, David C. Dale, MD 2, Jeffrey Crawford, MD 3, Gary H. Lyman, MD, MPH 3 *
1Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
2Department of Medicine, University of Washington School of Medicine, Seattle, Washington
3Department of Medicine, Duke University Medical Center, Durham, North Carolina
email: Gary H. Lyman (gary.lyman@duke.edu)

*Correspondence to Gary H. Lyman, Duke University Medical Center, DUMC 3645, Durham, NC 27710
Fax: (919) 681-7488

Keywords
aging, colony-stimulating factor, dose intensity, dose, neutropenic complications

Abstract

BACKGROUND.
This prospective study was undertaken to evaluate patient and treatment characteristics that contribute to hematologic toxicity in older cancer patients.

METHODS.
A nationwide study of 115 community oncology practices was conducted between 2002 and 2005 with data collected on 976 patients who had received chemotherapy for common malignancies, including lung cancer, colorectal cancer, breast cancer, ovarian cancer, genitourinary cancer, and lymphoma. Primary outcomes included severe neutropenia (SN) and febrile neutropenia (FN). Secondary outcomes included delivered relative dose intensity (RDI) <85%, dose delays 15% days, and reductions 15%.

RESULTS.
Approximately 50% of both patients with early-stage disease and patients with advanced-stage disease received an actual RDI <85%, and this rate reached 60% in the oldest group (aged >80 years). Increasing age was associated with lower actual RDI (P = .030) and averaged 87.5% across all elderly age groups. A decreasing trend in SN or FN events occurred with increasing age (P for trend = .039), with the majority of initial neutropenic events occurring in Cycle 1 for all age groups. Among the patients who received an actual RDI 85%, there was no significant difference in SN or FN by age group or disease stage. Independent risk factors for the development of SN or FN included cancer type, planned RDI 85%, body surface area 2m2, anthracycline- or platinum-based regimens, previous chemotherapy, elevated blood urea nitrogen, and alkaline phosphatase. Neutropenic complications decreased significantly with primary colony-stimulating factor (CSF) prophylaxis (coefficient of determination [R2] = 0.260; c-statistic = 0.782).

CONCLUSIONS.
Among cancer patients aged 70 years, 50% of whom received relatively full-dose chemotherapy, increasing age alone did not increase the risk of hematologic toxicity. Cancer 2007. © 2007 American Cancer Society.
Received: 13 February 2007; Revised: 23 May 2007; Accepted: 24 May 2007