TY - JOUR
T1 - Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer
AU - Magnuson, Allison
AU - Sedrak, Mina S.
AU - Gross, Cary P.
AU - Tew, William P.
AU - Klepin, Heidi D.
AU - Wildes, Tanya M.
AU - Muss, Hyman B.
AU - Dotan, Efrat
AU - Freedman, Rachel A.
AU - O'Connor, Tracey
AU - Dale, William
AU - Cohen, Harvey J.
AU - Katheria, Vani
AU - Arsenyan, Anait
AU - Levi, Abrahm
AU - Kim, Heeyoung
AU - Mohile, Supriya
AU - Hurria, Arti
AU - Sun, Can Lan
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2021/2/20
Y1 - 2021/2/20
N2 - PURPOSELimited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer.METHODSPatients of age ≥ 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 chemotherapy toxicity. Logistic regression with best-subsets selection was used to identify and incorporate independent predictors of toxicity into a model with weighted variable scoring. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics. The model was internally and externally validated.RESULTSIn 473 patients (283 in development and 190 in validation cohort), 46% developed grade 3-5 chemotherapy toxicities. Eight independent predictors were identified (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration > 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). We calculated risk scores for each patient and defined three risk groups: low (0-5 points), intermediate (6-11 points), or high (≥ 12 points). In the development cohort, the rates of grade 3-5 chemotherapy toxicity for these three groups were 19%, 54%, and 87%, respectively (P <.01). In the validation cohort, the corresponding toxicity rates were 27%, 45%, and 76%. The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity (P <.01).CONCLUSIONThe Cancer and Aging Research Group-Breast Cancer (CARG-BC) score was developed and validated to predict grade 3-5 chemotherapy toxicity in older adults with early-stage breast cancer.
AB - PURPOSELimited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer.METHODSPatients of age ≥ 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 chemotherapy toxicity. Logistic regression with best-subsets selection was used to identify and incorporate independent predictors of toxicity into a model with weighted variable scoring. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics. The model was internally and externally validated.RESULTSIn 473 patients (283 in development and 190 in validation cohort), 46% developed grade 3-5 chemotherapy toxicities. Eight independent predictors were identified (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration > 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). We calculated risk scores for each patient and defined three risk groups: low (0-5 points), intermediate (6-11 points), or high (≥ 12 points). In the development cohort, the rates of grade 3-5 chemotherapy toxicity for these three groups were 19%, 54%, and 87%, respectively (P <.01). In the validation cohort, the corresponding toxicity rates were 27%, 45%, and 76%. The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity (P <.01).CONCLUSIONThe Cancer and Aging Research Group-Breast Cancer (CARG-BC) score was developed and validated to predict grade 3-5 chemotherapy toxicity in older adults with early-stage breast cancer.
UR - http://www.scopus.com/inward/record.url?scp=85102211808&partnerID=8YFLogxK
U2 - 10.1200/JCO.20.02063
DO - 10.1200/JCO.20.02063
M3 - Article
C2 - 33444080
AN - SCOPUS:85102211808
SN - 0732-183X
VL - 39
SP - 608
EP - 618
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 6
ER -