Can Oncologists afford to reduce chemotherapy intensity in older patients? Is there a price to be paid by intensive therapy, or, conversely, a price to be paid by treating too gently? A number of investigators have addressed this issue, none better than Dr. Hyman Muss on behalf of the cooperative Oncology group called the Cancer and Acute Leukemia Group B (CALGB). In a recent Journal of Clinical Oncology, he published the long-term results of a study initiated in the mid-2000′s. Click here to read the abstract. Dr. Stark can provide the entire arcticle if you request it (fill out the form on the right of this page) but can’t link it because of copyright issues.
Dr. Muss and colleagues addressed this issue by conducting a large clinical study in which women 65 and older with operable breast cancer were treated either with traditional combination chemotherapy — cytoxan and either adriamycin or methotrexate/5FU — or oral capecitabine, a more gentle chemotherapy pill. Over 300 patients were in each group. About half of the patients were considered relatively good-risk for survival, and about 25% had such a good prognosis that today they might not be given any chemotherapy, as therapy has become more targeted with the advent of sophisticated tumor genetic mutation studies.
What they found was that gentle chemotherapy yielded results that were slightly inferior to the traditional combinations. However, the death rate from breast cancer was low in both groups and was overshadowed by death from other causes.
Dr. Stark comments: combination chemo was well tolerated and produced better results, so there is no excuse for avoiding it except possibly in extremely frail elderly women. Death from competing causes was sobering but important news to Oncologists facing the need to make decisions on behalf of their patients.