Docetaxel/cyclophosphamide chemotherapy in older patients with breast cancer

Abstract

Docetaxel/cyclophosphamide (TC) has become a standard chemotherapy for patients aged ≥65 years with high-risk early breast cancer (EBC) because of the absence of cardiotoxicity. 1 However in the phase III study, the median age was 51 years and 16% of patients were ≥65 years. 2,3 In this single-center retrospective analysis, we investigated the specific tolerance of TC in older women with EBC in routine daily practice at the UZ Brussel, Brussels, Belgium. From January 2010 till December 2012, 42 female patients aged ≥65 years with EBC were treated with (neo) adjuvant TC. The median age was 71 years old (range 65-82) and 30% of patients were ≥75 years. Seven patients (16.7%) had a HER2 amplification and were treated concomitantly with trastuzumab. Forty-one patients received pegfilgrastim most frequently as primary prophylaxis (pp) (81%). The observed adverse events (AEs) are listed in Table 1. All patients reported at least one AE and 15 patients (35.7%) experienced a grade 3/4 AE. The most common haematological toxicity was anemia (83.3%), mainly grade 1/2. Grade 3/4 neutropenia was observed in nine patients (21.5%), of whom four had received pp pegfilgrastim. Two patients presented with febrile neutropenia.The most common nonhaematological toxicities were fatigue (69%), diarrhea (54.8%), constipation (38.1%) and edema (38.1%).Thirteen patients (31%) developed infections, all but one in the absence of neutropenia. Ten patients (27%) were hospitalized because of serious nonhaematological AEs: five patients with infections, three with gastrointestinal AEs, one with pulmonary embolism and one interstitial pneumonitis (IP) in a patient treated concomitantly with trastuzumab, which resulted in a treatment-related death. Table 2 compares the TC related AEs reported in the present trial and in three previously published reports. 2,4,5In all reports, haematological toxicities were frequently observed with the TC regimen, most prominently neutropenia. In the present analysis, neutropenia and febrile neutropenia were less frequent

Retrospective comparison of two consecutive cohorts of adjuvant chemotherapy regimens of cyclophosphamide with either docetaxel or paclitaxel in older patients with early breast cancer

“…6 In a previous retrospective analysis of the TC regimen in unselected elderly patients with high-risk early BC, important adverse events were encountered. 7 On the other hand, three trials, one in metastatic disease 8 and two in the adjuvant setting 9,10 with weekly paclitaxel demonstrated significant superiority over three-weekly docetaxel, both for efficacy and safety end points. Therefore we introduced adjuvant three-weekly cyclophosphamide in combination with weekly paclitaxel (PC) for four cycles in high-risk patients above 65 years.…”