Optimal delivery of anthracycline-based chemotherapy in the adjuvant setting improves outcome of breast cancer patients

Chirivella, Isabel; Bermejo, B.; Insa, Amelia; Pérez-Fidalgo, Alejandro; Magro, A.; Roselló, Susana; García-Garré, Elisa; Martín, Paloma Leticia; Bosch, Ana; Lluch, Aña

doi:10.1007/s10549-008-0018-1

Cited by 156 publications

(99 citation statements)

References 20 publications

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“…FN can be life-threatening, with up to 9.5 % in-hospital mortality reported [11]. FN can lead to reduced chemotherapy dose delivery and subsequently, reduced chemotherapy efficacy [12][13][14]. Guidelines recommend use of G-CSF primary prophylaxis in patients with C 20 % risk of FN based on chemotherapy regimen and individual patient characteristics, while secondary prophylaxis is recommended in the subsequent cycle after an FN event [15,16].…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy treatment patterns and neutropenia management in gastric cancer

et al. 2014

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Background Potentially myelosuppressive doublet and triplet chemotherapy combination regimens are considered the most active treatments in gastric cancer. This multicenter prospective observational study was designed to gain insight into the chemotherapy regimens being used in Europe and to evaluate neutropenia management in patients identified as at high risk for febrile neutropenia (FN). Methods Eligible patients had gastric cancer, were scheduled for C 3 cycles of myelosuppressive chemotherapy, and had an investigator-assessed overall FN risk C 20 %. Data were collected for up to ten cycles. The primary endpoint was the proportion of patients who received granulocyte colony stimulating factor (G-CSF) primary prophylaxis (defined as G-CSF initiated on days 1-7 of cycle 1). Secondary endpoints included FN incidence, chemotherapy administration, and G-CSF use. Results Of 199 patients who met the eligibility criteria and started at least one cycle of chemotherapy, mean age was 63 years, 76 % were men, 83 % had an ECOG score of 0 or 1, 54 % had metastatic disease, and 24 % had received prior chemotherapy. A total of 27 different backbone regimens were given; the most common regimen was modified docetaxel, cisplatin, and 5-fluorouracil (DCF). Despite all patients having been identified as having a C 20 % FN risk, only 70 (35 %) received G-CSF primary prophylaxis. FN occurred in 14 patients overall (7 %). Most FN events occurred in patients who received DCF/modified DCF (9/14 events, 64 %). Conclusions The results of this study reveal a high use of myelotoxic treatment regimens in gastric cancer in Europe and low adherence to clinical practice guidelines for the use of primary and secondary G-CSF prophylaxis for FN.

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Section: Introductionmentioning

confidence: 99%

Chemotherapy treatment patterns and neutropenia management in gastric cancer

et al. 2014

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“…lativen Dosisintensität mit einer Verschlechterung des Gesamtüberlebens einhergeht, mahnte Untch [6]. Indiziert ist die Primärprophylaxe mit einem G-CSF laut AGO-Empfehlungen bei einem zu erwartenden FN-Risiko >20%, wie es bei einer dosisdichten Chemotherapie regelhaft der Fall ist [7].…”

Section: Optimierung Der Neoadjuvanten Chemotherapieunclassified

PharmaForum

2015

Breast Care

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“…In the adjuvant setting higher dose intensity is associated with better overall survival (OS) and disease-free survival (DFS) in breast cancer. 13,14 However, although treatment-related mortality is low in the adjuvant setting, 15,16 many oncologists will have seen their patients endure significant and occasionally life-threatening toxicity. Therefore, the recommendations of the NSW Department of Health acknowledged that medical oncologists may modify these treatment protocols where clinically appropriate.…”

Section: Introductionmentioning

confidence: 99%

Dose modifications in adjuvant chemotherapy for solid organ malignancies: A systematic review of clinical trials

Prasanna

Beith

Kao

et al. 2018

Asia-Pac J Clncl Oncology

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Toxicities of systemic cancer therapies are often less frequently observed in clinical trials than in clinical practice, due to the careful selection of patients with fewer comorbidities. Although guidelines exist for the estimation of chemotherapy dose, clinical factors like age, comorbid illness and extremes of body habitus are not considered in the method of dose calculation, which can result in significant toxicity. We reviewed the referenced clinical trials from which the evidencebased curative-intent cancer treatment protocols were developed for EVIQ, which is an Australian government, online resource. This review shows that a significant proportion of patients in curative-intent clinical trials experience toxicities that result in dose modifications-dose reduction, dose delays or missed doses-despite strict selection criteria and intense monitoring.

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Optimal delivery of anthracycline-based chemotherapy in the adjuvant setting improves outcome of breast cancer patients

Cited by 156 publications

References 20 publications

Chemotherapy treatment patterns and neutropenia management in gastric cancer

Chemotherapy treatment patterns and neutropenia management in gastric cancer

PharmaForum

Dose modifications in adjuvant chemotherapy for solid organ malignancies: A systematic review of clinical trials

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