Risk Score Identifies Adjuvant Chemotherapy Toxicity Risk in Elderly Patients With Breast Cancer
The aim of this study was to develop a tool to evaluate the risk of chemotherapy toxicity among older patients with breast cancer.
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A validated tool, the Cancer and Aging Research Group for Breast Cancer (CARG-BC), predicted risk of developing chemotherapy toxicity among older patients with breast cancer and was associated with dose alterations and hospitalization, according to data from a study presented at the 2018 San Antonio Breast Cancer Symposium in Texas.1
Patients older than age 65 with breast cancer are at an increased risk of developing toxicity associated with adjuvant chemotherapy, but no breast cancer–specific tools are available to assess this risk. The CARG previously developed and validated a tool to evaluate the risk of chemotherapy toxicity among older patients with any solid tumor. The aim of this study was to develop and validate a similar tool that was specific to breast cancer.
“We developed and validated a risk score (CARG-BC) that identifies an older patient's risk for adjuvant breast cancer chemotherapy toxicity,” the researchers stated.
The study evaluated 473 patients 65 years of age and older with stage I to III breast cancer with planned adjuvant chemotherapy treatment as part of development and validation cohorts. In the development cohort, the mean age was 70 (range, 65-85) and 39% had stage I disease, 41% had stage II diseaese, and 20% had stage III disease. Most patients had hormone receptor–positive disease (65%), followed by HER2-positive (27%), and triple-negative (24%) disease.
The score was developed to evaluate grade 3 to 5 toxicity, which occurred in 46% of patients. The majority of adverse events (AEs) were grade 3 (36%), followed by grade 4 (10%), and grade 5 (0.4%).
The previously developed CARG score was significantly associated with the development of grade 3 to 5 toxicities (P < .001; area under the curve [AUC], 0.64). The association improved with the addition of breast cancer–specific tumor and therapy characteristics, with an AUC of 0.76 (95% CI, 0.70-0.82; goodness of fit P = .28), which was also significantly associated with the incidence of grade 3 to 5 toxicities (P < .001).
Dose delay or reduction, reduced relative dose intensity, chemotherapy discontinuation, and hospitalization were significantly associated with a higher CARG-BC score (all P < .001).
The authors concluded that these data indicate that “this tool could be considered as a part of adjuvant therapy decision-making.”
Read more of Cancer Therapy Advisor's coverage of the SABCS 2018 meeting by visiting the conference page.
- Hurria A, Magnuson A, Gross CP, et al. Development and validation of a chemotherapy toxicity (Chemo Tox) risk score for older patients (Pts) with breast cancer (BC) receiving adjuvant/neoadjuvant treatment (Adjuvant Tx): A R01 and BCRF funded prospective multicenter study. Presented at: 2018 San Antonio Breast Cancer Symposium; December 4-8, 2018; San Antonio, TX. Abstract GS6-04.