Doxorubicin-based adjuvant chemotherapy in elderly breast cancer patients:The M.D. Anderson experience, with long-term follow-up

Background: The purpose of this study was to evaluate the clinical outcome of doxorubicin-based adjuvant chemotherapy in elderly breast cancer patient s and to compare results in elderly patients with those in younger patients . Patients and methods: We retrospectively reviewed the records of all patien ts aged 50 years or older treated in trials of doxorubicin-based adjuvant c hemotherapy between 1974 and 1988. Old age was not an exclusion criterion f or these trials. Patient characteristics, hematologic and nonhematologic si de effects, patterns of recurrence, and causes of death were determined for patients aged 50-64 years and for patients aged 65 years or older, and res ults were compared between these two groups. Kaplan-Meier survival curves w ere plotted, and tested by the generalized Wilcoxon test. Results: A total of 390 patients aged 50 years or older were treated with d oxorubicin-based adjuvant chemotherapy during the study period. Of these, 3 25 were aged 50-64 years (group 1), and 65 were aged 65 years or older (gro up 2). The median follow-up period for group 1 was 185 months (range 29-272 + months), and the median follow-up period for group 2 was 169 months (rang e 128-240+ months). There were no statistically significant differences bet ween the two groups with respect to performance status, hormone receptor pr ofile, tumor size, nodal status, or type of locoregional therapy. There als o were no statistically significant differences between the two groups in r ecurrence patterns, disease-free survival, or overall survival. The granulo cyte and platelet nadirs of cycles 1, 3, and 6 were similar between the two groups. No cumulative hematologic side effects were seen in either group. The occurrence of second malignancies was extremely low in both groups. In both groups, the majority of deaths were due to progression of disease. Conclusions: Adjuvant doxorubicin-based chemotherapy is well tolerated in e lderly breast cancer patients who have good performance status and normal c ardiac ejection fraction. Adjuvant doxorubicin-based chemotherapy in these patients results in disease-free and overall survival rates similar to thos e seen in younger patients.