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Kjeldsted E, Gehl J, Sørensen DM, Lodin A, Ceballos SG, Dalton SO. Patient-Related Characteristics Associated with Treatment Modifications and Suboptimal Relative Dose Intensity of Neoadjuvant Chemotherapy in Patients with Breast Cancer-A Retrospective Study. Cancers (Basel) 2023; 15:cancers15092483. [PMID: 37173949 PMCID: PMC10177586 DOI: 10.3390/cancers15092483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Reduced relative dose intensity (RDI) of neoadjuvant chemotherapy (NACT) in patients with breast cancer may compromise treatment outcome and survival. We examined patient-related characteristics associated with treatment modifications and suboptimal RDI and tumour response in patients with breast cancer. METHODS In this observational study, electronic medical records were reviewed retrospectively for female patients with breast cancer scheduled for NACT at a university hospital in Denmark between 2017 and 2019. The RDI (ratio of delivered dose intensity in relation to standard dose intensity) was calculated. Multivariate logistic regression analyses examined associations of sociodemographics, general health and clinical cancer characteristics with dose reductions, dose delays, discontinuation of NACT and suboptimal RDI < 85%. RESULTS Among 122 included patients, 43%, 42% and 28% experienced dose reductions, dose delays ≥3 days and discontinuation, respectively. A total of 25% received an RDI < 85%. Comorbidity, taking long-term medications and being overweight were statistically significantly associated with treatment modifications, while age ≥ 65 years and comorbidity were associated with RDI < 85%. Around one third of all patients had radiologic (36%) or pathologic (35%) complete tumour response, with no statistically significant differences by RDI < or ≥85% irrespective of breast cancer subtype. CONCLUSIONS While most patients had RDI ≥85%, still one out of four patients received an RDI < 85%. Further investigations of possible supportive care initiatives to improve patients' treatment tolerability are needed, particularly among subgroups of older age or with comorbidity.
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Affiliation(s)
- Eva Kjeldsted
- Danish Research Center for Equality in Cancer (COMPAS), 4700 Næstved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Dina Melanie Sørensen
- Danish Research Center for Equality in Cancer (COMPAS), 4700 Næstved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Alexey Lodin
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
| | | | - Susanne Oksbjerg Dalton
- Danish Research Center for Equality in Cancer (COMPAS), 4700 Næstved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4700 Næstved, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Mitigating acute chemotherapy-associated adverse events in patients with cancer. Nat Rev Clin Oncol 2022; 19:681-697. [PMID: 36221000 DOI: 10.1038/s41571-022-00685-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
Despite the enthusiasm surrounding novel targeted agents and immunotherapies, chemotherapy remains the mainstay treatment for most human malignancies, either alone or in combination. Yet, the burden of chemotherapy-associated adverse events (CAAEs) remains high and, importantly, is associated with considerable morbidity, mortality and costs that affect patients across multiple dimensions, including physical, emotional and social functioning. CAAEs can directly affect patient outcomes and indirectly increase the risk of cancer recurrence by compromising treatment intensity and continuity. Systematic efforts to identify and critically summarize the evidence on management approaches for CAAEs remain limited. Herein, we review the most common acute CAAEs having a major effect on survival, quality of life, function and/or continuation of optimal therapy. We focus on selected acute toxicities that occur during treatment, summarizing their underlying pathophysiology, multifactorial aetiologies, evidenced-based treatments, prevention strategies and management recommendations. We also summarize the available evidence on risk factors, validated risk assessment tools and other efforts to optimize symptom control in patients most likely to benefit in order to personalize the prevention and treatment of acute CAAEs. Finally, we discuss innovative symptom monitoring and supportive care interventions that are under development to further improve the outcomes of patients with cancer.
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Sbrana A, Antonuzzo A, Danova M. Cytokinetic-driven myeloprotection after cytotoxic chemotherapy: from an old idea to a new clinical approach. Support Care Cancer 2022; 30:7057-7060. [PMID: 35484313 DOI: 10.1007/s00520-022-07084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
Chemotherapy is the backbone of the treatment of several solid tumours and lymphomas. Myelotoxicity is often a dose-limiting toxicity and myeloprotection has always been investigated. In fact, over the years, several approaches have been studied in order to reduce the incidence of haematological toxicities and allow patients to receive effective, full-dose, chemotherapy. After the use of stimulating factors, such as granulocyte colony-stimulating factors and erythropoiesis-stimulating agents, in the very last years, a new approach has emerged. Trilaciclib, a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor, has been studied and it has been demonstrated in several clinical trials to reduce the incidence of myelotoxicity in small-cell lung cancer patients treated with chemotherapy or chemo-immunotherapy. Its potential role has not been fully studied yet, but it represents a highly effective tool to reduce myelotoxicity, widen the applicability of full-dose chemotherapy, even in frailer patients, and finally to increase the efficacy of chemotherapy in those tumours where relative dose intensity is a standard to achieve to get the best clinical results.
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Affiliation(s)
- Andrea Sbrana
- Service of Pneumo-Oncology, Pneumology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
| | - Andrea Antonuzzo
- Medical Oncology Unit 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Danova
- Dept. of Internal Medicine and Oncology, ASST of Pavia, Pavia, Italy
- LIUC University, Castellanza, Varese, Italy
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Miura K, Takahashi H, Nakagawa M, Hamada T, Uchino Y, Iizuka K, Ohtake S, Iriyama N, Hatta Y, Nakamura H. Ideal dose intensity of R-CHOP in diffuse large B-cell lymphoma. Expert Rev Anticancer Ther 2022; 22:583-595. [PMID: 35472312 DOI: 10.1080/14737140.2022.2071262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, its ideal dose intensity varies among cases. AREAS COVERED This review provides the latest insights on the dose intensity of R-CHOP for DLBCL patients. Specifically, we discussed the optimal dose intensity for elderly patients, the optimal number of treatment cycles for limited or advanced-stage diseases, and the role of dose-intensified therapies or adding targeted inhibitors. EXPERT OPINION Performing a comprehensive or simplified geriatric assessment can distinguish elderly DLBCL patients who will likely benefit from curative R-CHOP. Very elderly or medically unfit patients may need dose reduction in R-CHOP; the Age, Comorbidities, and Albumin index may aid decision-making. Four cycles of R-CHOP followed by two rituximab cycles comprise a new standard for low-risk, limited-stage DLBCL patients. Compared to eight cycles, six cycles of R-CHOP have similar efficacy and fewer toxicities for advanced-stage DLBCL. Dose-intensified therapy is not recommended in most DLBCL cases but may be considered for patients with double (or triple)-hit lymphoma. Applying targeted inhibitors and not merely escalating R-CHOP dose intensity through molecular subtyping will improve the treatment outcome for DLBCL.
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Affiliation(s)
- Katsuhiro Miura
- Tumor Center, Nihon University Itabashi Hospital (Director); 2Department of Hematology and Rheumatology, Nihon University School of Medicine (Associate Professor), Tokyo, Japan.,Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromichi Takahashi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Masaru Nakagawa
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Takashi Hamada
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihito Uchino
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Iizuka
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Shimon Ohtake
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Nakamura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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