Toxicity of Older and Younger Patients Treated With Adjuvant Chemotherapy for Node-Positive Breast Cancer: The Cancer and Leukemia Group B Experience

PURPOSE: Increased microvessel density (MVD), a reflection of tumor angiogenesis, is associated with diminished relapse-free and overall survival (OS) in several subsets of breast cancer patients. However, the utility of this assay in node-positive patients treated with adjuvant cyclophosphamide, doxorubicin, and fluorouracil (CAF) has not been well studied. PATIENTS AND METHODS: Immunostaining for factor VIII–related antigen was performed on tissue sections from a subset of node-positive patients who received one of three dose/schedule regimens of CAF during participation in Cancer and Leukemia Group B protocol 8541. Sections from 577 cancers exhibited acceptable tumor and immunostaining quality and were included in the study. Each section was examined quantitatively for MVD as well as nonquantitatively by scoring the presence or absence of a prominent vascular pattern. RESULTS: MVD counts were not associated with relapse-free or OS in univariate analysis. The presence of a prominent plexiform vascular pattern was correlated with decreased OS (P = .0085) in univariate analysis, but this pattern was not an independent prognostic indicator of survival in multivariate analysis. No apparent clinically important interactions between measures of angiogenesis, other prognostic factors, administration of tamoxifen, and chemotherapy dose were observed. CONCLUSION: Assessment of angiogenesis does not provide useful information regarding prognosis in node-positive breast cancer patients treated with adjuvant CAF, nor do these measures predict which patients will benefit from dose intensification or addition of tamoxifen.

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Weight gain after adjuvant TAC (docetaxel, doxorubicin, and cyclophosphamide) chemotherapy for node-positive breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e11552 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e11552-e11552

Author(s):

Y. Suh ◽

S. Oh ◽

B. Song ◽

S. Jung

Keyword(s):

Breast Cancer ◽

Weight Gain ◽

Adjuvant Chemotherapy ◽

Randomized Trials ◽

Fluid Retention ◽

Node Positive ◽

Tac Chemotherapy ◽

Group A ◽

Group B ◽

Positive Breast Cancer

e11552 Background: Despite of its proven therapeutic efficacy, TAC (docetaxel, Doxorubicin and cyclophosphamide) regimen as an adjuvant chemotherapy has some serious adverse effects such as fluid retention and neutropenia. Even though dexamethasone is known to be given for three days to the patients having TAC chemotherapy to prevent severe fluid retention, most patients have ironically been complaining of much weight gain more than 15% increase after the use of dexamethasone. We tried to determine abbreviated use of dexamethasone is better to decrease the extent of weight gain after TAC chemotherapy. Methods: Eighty node-positive patients between Jan. 2006 and Oct. 2007 were randomly assigned either into 24-hr (group A: 10 mg dexamethasone the night before TAC, and 10 mg dexamethasone (bid) were given for the day 1) or 72-hr dexamethasone premedication (group B) only after getting informed consent since all the protocols were reviewed by IRB. We compared the incidence of severe weight gain (more than 15%) on completion of six cycles in two groups. No patient was found to have heart or kidney problem before the commencement of chemotherapy. Results: Each group was comprised of 40 patients. All patients underwent 6 cycles. Mean age of each group was 48.5 (A) and 50.3 (B) years. The incidence of severe weight gain was 47.3 % in Group A, and 78.4 % in Group B. There was no difference in the duration of recovering from weight gain in both groups (A: 6.52 months vs. B: 7.02 months). No other hematologic complications seemed different between two groups. Conclusions: Though larger scale prosepctive randomized trials should be required to get the definitive conclusion on this matter, we think that current dexamethasone premedication may aggravate weight gain than to prevent it. If shorter schedule is as much effective as longer one, abbreviated and reduced dexamethasone premedication is more helpful for patients having TAC chemotherapy. No significant financial relationships to disclose.

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Effect of addition of paclitaxel on radiotherapy delivery and locoregional control of node positive breast cancer: Cancer and Leukemia Group B 9344

The Women s Oncology Review ◽

10.1080/14733400500154080 ◽

2005 ◽

Vol 5 (1) ◽

pp. 61-62

Author(s):

Bruce Haffty

Keyword(s):

Breast Cancer ◽

Locoregional Control ◽

Node Positive ◽

Group B ◽

Leukemia Group ◽

Positive Breast Cancer

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Effect of Addition of Adjuvant Paclitaxel on Radiotherapy Delivery and Locoregional Control of Node-Positive Breast Cancer: Cancer and Leukemia Group B 9344

Journal of Clinical Oncology ◽

10.1200/jco.2005.12.044 ◽

2005 ◽

Vol 23 (1) ◽

pp. 30-40 ◽

Cited By ~ 75

Author(s):

Carolyn I. Sartor ◽

Bercedis L. Peterson ◽

Susan Woolf ◽

Thomas J. FitzGerald ◽

Frances Laurie ◽

...

Keyword(s):

Breast Cancer ◽

Cumulative Incidence ◽

Treatment Interruption ◽

Breast Conserving Surgery ◽

Locoregional Control ◽

Node Positive ◽

Group B ◽

To Receive ◽

Leukemia Group ◽

Positive Breast Cancer

Purpose We compared radiotherapy (RT) delivery and locoregional control in patients with node-positive breast cancer randomly assigned on Cancer and Leukemia Group B 9344 to receive adjuvant doxorubicin/cyclophosphamide (AC) with patients assigned to receive AC followed by paclitaxel (AC+T). Methods Eligible patients were randomly assigned to receive adjuvant AC versus AC+T chemotherapy. RT was required if breast-conserving surgery was performed but was elective after mastectomy. Information about RT delivery was retrospectively collected. Cumulative incidence of locoregional recurrence (LRR), use of elective RT, and RT delivery were compared between treatment arms. Results For patients treated with breast-conserving surgery and RT, the 5-year cumulative incidence of isolated LRR was 9.7% in the AC arm and 3.7% in the AC+T arm (P = .04) and of LRR as any component of failure was 12.9% versus 6.1%, respectively (P = .04). Although LRR rates in patients who did not receive postmastectomy RT were lower in the AC+T arm, the difference was not statistically significant. Despite the lack of protocol guidelines, RT use did not differ between arms, nor did RT dose, treatment interruption, or completion. Conclusion Despite the delay to RT during additional chemotherapy, adjuvant AC+T afforded better local control than AC alone in patients treated with breast-conserving therapy. Addition of paclitaxel did not adversely affect delivery or ability to tolerate RT, as indicated by similar rates of completion of timely, full-dose RT between arms.

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Toxicity of Older and Younger Patients Treated With Adjuvant Chemotherapy for Node-Positive Breast Cancer: The Cancer and Leukemia Group B Experience

Journal of Clinical Oncology ◽

10.1200/jco.2007.10.9710 ◽

2007 ◽

Vol 25 (24) ◽

pp. 3699-3704 ◽

Cited By ~ 192

Author(s):

Hyman B. Muss ◽

Donald A. Berry ◽

Constance Cirrincione ◽

Daniel R. Budman ◽

I. Craig Henderson ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Older Patients ◽

Hematologic Toxicity ◽

Younger Patients ◽

Node Positive ◽

Increased Risk ◽

Nonhematologic Toxicity ◽

Grade 3 ◽

Group B ◽

Leukemia Group

PurposeOlder node-positive patients treated with newer adjuvant chemotherapy regimens have improvements in relapse-free and overall survival similar to younger patients. We compared toxicity of older and younger patients in three randomized trials of adjuvant chemotherapy.Patients and MethodsToxicity data were available for 93% of 6,642 patients enrolled. The three trials included: Cancer and Leukemia Group B (CALGB) 8541, a comparison of cyclophosphamide, doxorubicin, and fluorouracil in three dose schedules; CALGB 9344: cyclophosphamide and doxorubicin with or without paclitaxel; and CALGB 9741: cyclophosphamide, doxorubicin, and paclitaxel every 2 versus every 3 weeks. National Cancer Institute grade 3 to 5 toxicities were compared among age groups.ResultsSeven percent of patients (n = 458) were age 65 or older, 3% were 70 or older, 38% were 51 to 64, and 55% were 50 or younger. Twenty-four deaths (0.4%) were attributed to treatment; seven (1.5%) of 486 in patients 65 or older, 10 (0.40%) of 2,480 in patients who were 51 to 64 years, and seven (0.19%) of 3,676 occurred in patients younger than 50. In multivariate analysis, older patients were significantly more likely to have grade 4 hematologic toxicity, to have discontinued treatment for toxicity, or to have died of acute myeloid leukemia/myelodysplastic syndrome. There were no significant differences in grade 3 to 4 nonhematologic toxicity.ConclusionHealthy older patients who met the strict eligibility criteria for these trials had a higher rate of hematologic toxicity and treatment-related deaths than younger patients, but no increase in nonhematologic toxicity. Elderly patients treated with newer adjuvant chemotherapy regimens derive the same benefits from newer chemotherapy regimens as younger patients but should be cautioned about the increased risk of toxicity and treatment-related death.

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