Associations between age and chemotherapy dose reductions in women with stage I-IIIA breast cancer
Menée aux Etats-Unis à partir de données 2004-2019 portant sur 10 166 patientes atteintes d'un cancer du sein de stade I à IIIA et recevant une chimiothérapie adjuvante, cette étude de cohorte analyse l'association entre l'âge au diagnostic et la réduction de dose du traitement
Background: Older women (>65 years) diagnosed with breast cancer may be at risk for chemotherapy dose reductions. We evaluated associations of age at diagnosis with two measures of chemotherapy dose reductions: first cycle dose proportion (FCDP) <90%, and average relative dose intensity (ARDI) <90%.
Methods: From the Optimal Breast cancer Chemotherapy Dosing study, we included 10,166 women aged 18+ years treated with adjuvant chemotherapy for stage I-IIIA breast cancer at Kaiser Permanente Northern California (KPNC) and Washington (KPWA) between 2004-2019. We examined associations between age at diagnosis with FCDP < 90% (reflecting clinician intent at chemotherapy initiation) and ARDI < 90% (reflecting average dose across the chemotherapy course). We used generalized linear models of the Poisson family with a log-link function and robust standard errors to calculate prevalence ratios (PR) for FCDP < 90% and ARDI < 90% with 95% confidence intervals (CI) adjusted for patient and tumor characteristics, with and without adjusting for pre-existing comorbidities. All tests for statistical significance were 2-sided.
Results: The proportion of women with FCDP < 90% ranged from 2.9% among women aged 18-39 years to 18.6% among women aged 75+ years. Before adjusting for comorbidities, women aged 75+ years were more likely to have FCDP < 90% (PR: 4.88; 95%CI: 3.58, 6.66) and ARDI < 90% (PR: 1.91; 95%CI: 1.58, 2.32) versus women aged 40-49 years. Results were similar after adjusting for comorbidities as a composite comorbidity score or individual comorbidities.
Conclusion: Older age at diagnosis was strongly associated with chemotherapy dose reductions in this population-based cohort, particularly at chemotherapy initiation but also across the course of treatment.
Journal of the National Cancer Institute , résumé, 2025