Higher dose chemotherapy improves survival from breast cancer
http://www.100md.com
《英国医生杂志》
Higher dose chemotherapy reduces overall risk of relapse after breast cancer by 22% compared with less aggressive regimens. Similar benefits were seen in older and younger women, results from a meta-analysis show (JAMA 2005;293:1073-81).
The study retrospectively analysed data from four randomised clinical trials of treatments for lymph node positive breast cancer in 1975-99. Each trial compared more aggressive with less aggressive chemotherapy regimens, including a treatment arm using drug doses or schedules that were regarded as being high.
A total of 6487 women with lymph node positive breast cancer were included, with 542 (8%) aged 65 years or older and 159 (2%) aged 70 years or older.
Results showed that the degree of chemotherapy was significantly related to disease-free survival and overall survival (P<0.001). Patients treated with more intensive chemotherapy were 22% less likely to relapse than patients who received less chemotherapy (hazard ratio 0.78, 95% confidence interval 0.72 to 0.85).
This benefit was consistent across all age groups. The chance of relapse was 18% (95% confidence interval 9% to 27%) lower for women aged 50 years or younger treated with higher intensity chemotherapy, 20% (8% to 30%) lower for women aged 51 to 64 years, and 42% lower (22% to 56%) for women aged 65 years or older.
The reduction in hazard of death due to more chemotherapy compared with less chemotherapy showed a similar benefit, with a reduction of 17% (6% to 27%) in women aged 50 years or younger, 16% (4% to 27%) in women aged 51 to 64 years, and 27% (5% to 44%) in women aged 65 years or older.
Death related to chemotherapy also increased with age, however. The overall mortality related to treatment was 0.5% (0.4% to 0.7%). The incidence of death related to treatment was 0.2% for women aged 50 years or younger, 0.7% for women aged 51-64, and 1.5% for women aged at least 65 (P<0.001).
Hyman Muss, professor of medicine at the Vermont Cancer Center, Burlington, Vermont, and lead author of the study, said, "Our findings add to the increasing number of trials that suggest that older patients in fair to good health tolerate standard chemotherapy regimens, and even more intensive regimens, almost as well as younger patients."
He warned that, despite this, many healthy older patients at high risk of recurrence were often not offered adjuvant chemotherapy. "Even when chemotherapy is administered to older patients, inappropriate dose reductions are frequently made that may decrease effectiveness," he warned.
The research group, including members of the Cancer and Leukemia Group B triallists, was also concerned about the under-representation of older women in breast cancer trials. In their analysis, only 8% of patients in the trials they assessed were aged 65 years or older. They estimated that about half of new diagnoses of breast cancer were in women in the older age group.(London Susan Mayor)
The study retrospectively analysed data from four randomised clinical trials of treatments for lymph node positive breast cancer in 1975-99. Each trial compared more aggressive with less aggressive chemotherapy regimens, including a treatment arm using drug doses or schedules that were regarded as being high.
A total of 6487 women with lymph node positive breast cancer were included, with 542 (8%) aged 65 years or older and 159 (2%) aged 70 years or older.
Results showed that the degree of chemotherapy was significantly related to disease-free survival and overall survival (P<0.001). Patients treated with more intensive chemotherapy were 22% less likely to relapse than patients who received less chemotherapy (hazard ratio 0.78, 95% confidence interval 0.72 to 0.85).
This benefit was consistent across all age groups. The chance of relapse was 18% (95% confidence interval 9% to 27%) lower for women aged 50 years or younger treated with higher intensity chemotherapy, 20% (8% to 30%) lower for women aged 51 to 64 years, and 42% lower (22% to 56%) for women aged 65 years or older.
The reduction in hazard of death due to more chemotherapy compared with less chemotherapy showed a similar benefit, with a reduction of 17% (6% to 27%) in women aged 50 years or younger, 16% (4% to 27%) in women aged 51 to 64 years, and 27% (5% to 44%) in women aged 65 years or older.
Death related to chemotherapy also increased with age, however. The overall mortality related to treatment was 0.5% (0.4% to 0.7%). The incidence of death related to treatment was 0.2% for women aged 50 years or younger, 0.7% for women aged 51-64, and 1.5% for women aged at least 65 (P<0.001).
Hyman Muss, professor of medicine at the Vermont Cancer Center, Burlington, Vermont, and lead author of the study, said, "Our findings add to the increasing number of trials that suggest that older patients in fair to good health tolerate standard chemotherapy regimens, and even more intensive regimens, almost as well as younger patients."
He warned that, despite this, many healthy older patients at high risk of recurrence were often not offered adjuvant chemotherapy. "Even when chemotherapy is administered to older patients, inappropriate dose reductions are frequently made that may decrease effectiveness," he warned.
The research group, including members of the Cancer and Leukemia Group B triallists, was also concerned about the under-representation of older women in breast cancer trials. In their analysis, only 8% of patients in the trials they assessed were aged 65 years or older. They estimated that about half of new diagnoses of breast cancer were in women in the older age group.(London Susan Mayor)