Policy Analysis Inc., Four Davis Court, Brookline, MA 02445, USA.
Breast Cancer Res Treat. 2012 May;133(1):301-10. doi: 10.1007/s10549-011-1949-5. Epub 2012 Jan 24.
Chemotherapy is widely used to treat early stage breast cancer (ESBC). Reductions and delays in dose administered--e.g., due to advanced age or febrile neutropenia (FN)--are generally believed to increase risk of disease progression and reduce survival. Little is known about incidence of reduced chemotherapy dose intensity among women with ESBC in the current era of US clinical practice. This study employed a retrospective cohort design and electronic medical records from > 65 community oncology/hematology clinics in > 35 states (2004-2010). The study population comprised adult women who received myelosuppressive chemotherapy for ESBC (stages I-IIIA). For each such woman, each unique cycle of chemotherapy within their first observed course was identified. Incidence of chemotherapy dose delays (≥ 7 days for any drug in ≥ 1 cycles), chemotherapy dose reductions (≥ 15% for any drug in ≥ 1 cycles), and low chemotherapy relative dose intensity (RDI <85% over the course) relative to published reference standards were descriptively analyzed for the seven most-frequently planned regimens in the study database. A total of 2,228 women (70% of the subjects who received chemotherapy for ESBC and met other selection criteria) initiated 1 of the 7 most-frequently planned regimens. Mean age of subjects was 54 years and 69% received primary prophylaxis against FN with a colony-stimulating factor. Incidence of dose delays, dose reductions, and low RDI was 31, 24, and 26%, respectively; low RDI typically was due to premature treatment discontinuation. For patients (n = 626) receiving the most common regimen (dose-dense AC-T: doxorubicin/cyclophosphamide, Q2 × 4 cycles, paclitaxel or docetaxel, Q2 × 4 cycles), incidence of dose delays, dose reductions, and low RDI was 42, 29, and 32%, respectively. In the current era of US clinical practice, chemotherapy dose delays and dose reductions are common among women with ESBC receiving frequently used myelosuppressive dose-dense, as well as conventional, chemotherapy regimens.
化疗被广泛用于治疗早期乳腺癌（ESBC）。剂量的减少和延迟给药 - 例如，由于年龄较大或发热性中性粒细胞减少症（FN） - 通常被认为会增加疾病进展的风险并降低生存率。在美国临床实践的当前时代，关于 ESBC 女性接受减少的化疗剂量强度的发生率知之甚少。本研究采用回顾性队列设计和来自 35 个州的 65 个以上社区肿瘤学/血液学诊所的电子病历（2004-2010 年）。研究人群包括接受骨髓抑制性化疗治疗 ESBC（I-IIIA 期）的成年女性。对于每位女性，在其首次观察疗程内的每个独特的化疗周期都被确定。根据发表的参考标准，对研究数据库中七种最常用的计划方案中的每个周期的化疗剂量延迟（任何药物的任何周期中延迟≥7 天）、化疗剂量减少（任何药物的任何周期中减少≥15%）和低化疗相对剂量强度（在整个疗程中<85%）的发生率进行描述性分析。共有 2228 名女性（接受 ESBC 化疗且符合其他选择标准的女性的 70%）开始了 7 种最常用计划方案中的 1 种。研究对象的平均年龄为 54 岁，69%的人接受了 FN 的预防性一级治疗。剂量延迟、剂量减少和低 RDI 的发生率分别为 31%、24%和 26%；低 RDI 通常是由于过早停止治疗。对于接受最常见方案（密集型 AC-T：阿霉素/环磷酰胺，Q2 × 4 个周期，紫杉醇或多西他赛，Q2 × 4 个周期）的患者（n = 626），剂量延迟、剂量减少和低 RDI 的发生率分别为 42%、29%和 32%。在美国临床实践的当前时代，接受常用骨髓抑制性密集型以及常规化疗方案治疗的 ESBC 女性中，化疗剂量延迟和剂量减少很常见。
