FCCC LOGO Faculty Publications
Magnuson A , Sedrak MS , Gross CP , Tew WP , Klepin HD , Wildes TM , Muss HB , Dotan E , Freedman RA , O'Connor T , Dale W , Cohen HJ , Katheria V , Arsenyan A , Levi A , Kim H , Mohile S , Hurria A , Sun CL
Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer
J Clin Oncol. 2021 Feb 20;39(6) :608-618
PMID: 33444080    PMCID: PMC8189621    URL: https://www.ncbi.nlm.nih.gov/pubmed/33444080
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PURPOSE: Limited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer. METHODS: Patients 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. RESULTS: In 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). CONCLUSION: The 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.
1527-7755 Magnuson, Allison Sedrak, Mina S Gross, Cary P Tew, William P Klepin, Heidi D Wildes, Tanya M Muss, Hyman B Dotan, Efrat Freedman, Rachel A O'Connor, Tracey Dale, William Cohen, Harvey J Katheria, Vani Arsenyan, Anait Levi, Abrahm Kim, Heeyoung Mohile, Supriya Hurria, Arti Sun, Can-Lan Journal Article United States J Clin Oncol. 2021 Jan 14:JCO2002063. doi: 10.1200/JCO.20.02063.