Dose intensity correlate with survival in elderly patients treated with chemotherapy for advanced non-small cell lung cancer. Luciani A,Bertuzzi C,Ascione G,Di Gennaro E,Bozzoni S,Zonato S,Ferrari D,Foa P Lung cancer (Amsterdam, Netherlands) INTRODUCTION:In elderly patients treated with chemotherapy for advanced non-small cell lung cancer (NSCLC), frequently an adequate dose intensity (DI) is difficult to be delivered. We therefore performed in this population a study to assess the delivered DI and its impact on clinical outcome. PATIENTS AND METHODS:Inclusion criteria were: age equal or greater than 70 years; cytological or histological diagnosis of NSCLC; stage IIIB or IV; no previous chemotherapy for advanced disease. Total relative dose intensity (RDI) was taken into account for the analysis. An RDI less than 80% was considered as suboptimal for tumor shrinkage. A survival comparison between subgroups (more or less than 80% RDI) was done. RESULTS:107 patients were eligible for the analysis. Mean age was 74.3 years. PS was 0-1 in 92.5% of subjects. Mean number of comorbidities was 1.86. The most frequently chemotherapy regimens used were single agent vinorelbine and single agent gemcitabine. Overall mean RDI was 68%; 36% of patients received a RDI>80% of the originally planned one. The objective response rate (RR) was 55.2% and 33.3% respectively for patients receiving more or less than 80% of the RDI (p<0.01); a significant difference in overall survival between these two groups (p<0.0001) was also recorded. Baseline hemoglobin and body mass index (BMI) were the variables that significantly influenced the delivered RDI. CONCLUSIONS:These data suggest that in elderly patients treated with chemotherapy for advanced NSCLC an adequate dose intensity has a significant positive impact on both response rate and overall survival. 10.1016/j.lungcan.2008.12.019

Maintaining Dose Intensity of Adjuvant Chemotherapy in Older Patients With Breast Cancer. Ladwa Rahul,Kalas Timothy,Pathmanathan Shivanshan,Woodward Natasha,Wyld David,Sanmugarajah Jasotha Clinical breast cancer INTRODUCTION:Maintaining the relative dose intensity (RDI) of adjuvant chemotherapy at ≥ 85% has been associated with improved treatment outcomes in early-stage breast cancer (ESBC). Increasing evidence has suggested that patients aged ≥ 65 years can maintain the optimal RDI for standard chemotherapy regimens. The present study investigated the RDI of newer adjuvant chemotherapy regimens in this demographic. PATIENTS AND METHODS:We retrospectively analyzed the data from 281 patients aged ≥ 65 years with a diagnosis of ESBC who had received adjuvant chemotherapy across 3 sites in Queensland, Australia from 2010 to 2015. The primary endpoint was the proportion of patients who had received an RDI of ≥ 85%. RESULTS:The median age at diagnosis was 68 years (range, 65-85 years), with 36.3% aged > 70 years. The patient characteristics included tumor stage T3 or T4 in 17% and node-positive disease in 60%. The common chemotherapy regimens included docetaxel/cyclophosphamide (23%), 5-fluorouracil/epirubicin/cyclophosphamide plus docetaxel or paclitaxel (17%); Adriamycin/cyclophosphamide/weekly paclitaxel (38%); and docetaxel/carboplatin/trastuzumab (11%). Primary (15%) and secondary (54%) granulocyte colony-stimulating factor (G-CSF) was used. An RDI of ≥ 85% was achieved in 63% of the patients. Significant associations were noted between a reduced RDI and age ≥ 70 years (P < .001), Charlson comorbidity index ≥ 1 (P = .043), initial dose reductions (P = .01), secondary G-CSF use (P = .45), hospital admission (P < .001), and febrile neutropenia (P = .007). Treatment-related toxicities were the most common reason for noncompletion, with high rates of hospital admissions (46%) and febrile neutropenia (22%). CONCLUSION:Our findings suggest that patients aged ≥ 65 years with ESBC can maintain an optimal RDI with modern chemotherapy regimens. Appropriate geriatric assessment and the use of supportive measures such as G-CSF could better assist select groups to maintain an optimal dose intensity. 10.1016/j.clbc.2018.04.016

Relative dose intensity of first-line chemotherapy and overall survival in patients with advanced non-small-cell lung cancer. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer PURPOSE:The effects of chemotherapy dose intensity on survival in patients with advanced non-small-cell lung cancer (NSCLC) are poorly understood. We retrospectively analyzed dose delays/reduction, relative dose intensity (RDI), and the association between chemotherapy intensity and survival in advanced NSCLC. METHODS:This retrospective cohort study included adults with advanced lung cancer who received first-line myelosuppressive platinum-based chemotherapy (January 2007-December 2010) in ~ 230 US Oncology Network community practices. Dose delays ≥ 7 days, dose reductions ≥ 15%, and RDI relative to standard regimens were described. Overall survival (OS) was measured using Kaplan-Meier and Cox proportional hazard (PH) models. RESULTS:Among 3866 patients with advanced NSCLC, 32.4% experienced dose delays ≥ 7 days, 50.1% experienced dose reductions ≥ 15%, and 40.4% had RDI < 85%. Reduced RDI was also common regardless of baseline ECOG PS (ECOG PS ≥ 2, 56.2%; ECOG PS 0, 33.6%) and tumor subgroup (squamous cell carcinoma, 52.2%; adenocarcinoma, 36.0%). When stratified by chemotherapy intensity measures, significant OS differences were observed only for dose delays. Median (95% CI) OS was 1.02 years (0.96-1.12) for dose delays ≥ 7 days and 0.71 years (0.66-0.77) for dose delays < 7 days. In multivariable Cox PH analysis, dose delays ≥ 7 days (HR = 0.71; 95% CI = 0.63-0.80) and RDI ≥ 85% (HR = 1.18; 95% CI = 1.05-1.32) were significantly associated with decreased mortality. CONCLUSIONS:Dose delays, dose reductions, and reduced RDI were common, and dose delays ≥ 7 days and high RDI were significantly associated with decreased mortality. These results can help identify potential risk factors and characterize the effect of chemotherapy dose modification strategies on mortality. 10.1007/s00520-019-04875-1