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Wildiers H, Tryfonidis K, Dal Lago L, Vuylsteke P, Curigliano G, Waters S, Brouwers B, Altintas S, Touati N, Cardoso F, Brain E. Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer (EORTC 75111-10114): an open-label, randomised, phase 2 trial from the Elderly Task Force/Breast Cancer Group. Lancet Oncol 2018; 19:323-336. [PMID: 29433963 DOI: 10.1016/s1470-2045(18)30083-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite the high incidence of metastatic breast cancer and its related mortality in the elderly population, our knowledge about optimal treatment for older patients with cancer is far from adequate. We aimed to evaluate the efficacy of dual anti-HER2 treatment with or without metronomic chemotherapy in older patients with HER2-positive metastatic breast cancer. METHODS We did a multicentre, open-label, randomised, phase 2 trial in 30 centres from eight countries in Europe, in patients with histologically proven, HER2-positive metastatic breast cancer, without previous chemotherapy for metastatic disease, who were 70 years or older, or 60 years or older with confirmed functional restrictions defined by protocol, and had a life expectancy of more than 12 weeks and a performance status according to WHO scale of 0-3. Eligible patients were randomly assigned (1:1) by an online randomisation system based on the minimisation method to receive metronomic oral cyclophosphamide 50 mg per day plus trastuzumab and pertuzumab, or trastuzumab and pertuzumab alone. Trastuzumab was given intravenously with a loading dose of 8 mg/kg, followed by 6 mg/kg every 3 weeks. Pertuzumab was given intravenously with a loading dose of 840 mg, followed by 420 mg every 3 weeks. Patients were stratified by hormone receptor positivity, previous HER2 treatment, and baseline geriatric screening. The primary endpoint was investigator-assessed progression-free survival at 6 months as per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. A difference of 10% or greater between the two groups was sought. Efficacy analyses were by intention to treat; safety was assessed in all patients who received at least one dose of study treatment. In case of progression, all patients were offered trastuzumab emtansine. This trial is registered with ClinicalTrials.gov, number NCT01597414, and is completed. FINDINGS Between July 2, 2013, and May 10, 2016, 80 patients, of whom 56 (70%) had a potential frailty profile according to the geriatric screening G8 score (≤14), were randomly assigned to receive trastuzumab and pertuzumab (n=39) or trastuzumab and pertuzumab plus metronomic oral cyclophosphamide (n=41). Estimated progression-free survival at 6 months was 46·2% (95% CI 30·2-60·7) with trastuzumab and pertuzumab versus 73·4% (56·6-84·6) with trastuzumab and pertuzumab plus metronomic oral cyclophosphamide (hazard ratio [HR] 0·65 [95% CI 0·37-1·12], p=0·12). At a median follow-up of 20·7 months (IQR 12·5-30·4), the median progression-free survival was 5·6 months (95% CI 3·6-16·8) with trastuzumab and pertuzumab versus 12·7 months (6·7-24·8) with the addition of metronomic oral cyclophosphamide. The most frequent grade 3-4 adverse events were hypertension (in six [15%] of 39 patients in the trastuzumab and pertuzumab group vs five [12%] of 41 in the trastuzumab and pertuzumab plus metronomic oral cyclophosphamide group), diarrhoea (four [10%] vs five [12%]), dyspnoea (two [5%] vs four [10%]), fatigue (three [8%] vs two [5%]), pain (two [5%] vs two [5%]), and a thromboembolic event (0 [0%] vs four [10%]). Severe cardiac toxicities were occasionally observed in both groups. In the trastuzumab and pertuzumab group four patients died without progression, due to cardiac arrest during treatment (n=1), peritoneal infection (n=1), respiratory failure (n=1), and sudden death without a specified cause (n=1). In the trastuzumab and pertuzumab plus metronomic oral cyclophosphamide group, one patient died from heart failure. INTERPRETATION Addition of metronomic oral cyclophosphamide to trastuzumab plus pertuzumab in older and frail patients with HER2-positive metastatic breast cancer increased median progression-free survival by 7 months compared with dual HER2 blockade alone, with an acceptable safety profile. Trastuzumab and pertuzumab plus metronomic oral cyclophosphamide, followed by trastuzumab emtansine after disease progression, might delay or supersede the need for taxane chemotherapy in this population. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Konstantinos Tryfonidis
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | - Peter Vuylsteke
- Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | - Giuseppe Curigliano
- Department of Hematology and Oncology, Division of Early Drug Development, University of Milano, Istituto Europeo di Oncologia, Milan, Italy
| | | | - Barbara Brouwers
- Department of Medical Oncology, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Sevilay Altintas
- Department of Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Nathan Touati
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Fatima Cardoso
- Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie (Hôpital René Huguenin) Saint-Cloud, France
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202
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Martinez-Ramos D, Simon-Monterde L, Queralt-Martin R, Suelves-Piqueres C, Menor-Duran P, Escrig-Sos J. Breast cancer in octogenarian. Are we doing our best? A population-registry based study. Breast 2018; 38:81-85. [PMID: 29274475 DOI: 10.1016/j.breast.2017.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The number of old people with breast cancer is estimated to increase during the next years in developed countries. However, management of breast cancer in octogenarians is not well established. The main objective was to evaluate if patients older than 80 years with breast cancer are receiving the most convenient treatment by using a population registry cancer analysis. PATIENTS AND METHODS A retrospective analysis of a population cancer registry was designed. Data were retrieved from the Castellon Cancer Registry (Valencian Community, Spain). Patient records were analyzed from January 1, 1995 to December 31, 2013. Two groups were defined: group A, <80 years; and group B, >= 80 years. Survival analyses were sequentially performed into three phases. First, a non-adjusted Kaplan Meier analysis was conducted. For the second survival analyses, Cox's proportional hazards model of Overall survival was used adjusting for condensed-TNM stage and adjuvant treatments. Finally, the third specific adjustment was carried out adding information of life expectancy by age for Spanish women, corresponding to year 2008 with condensed-TNM stage and Propensity Score variable, as an approximation to relative or disease-specific survival. RESULTS The total number of included patients was 1304. Women ≥80 years presented a more extended disease, larger tumors and less in situ carcinomas. A lower proportion of women ≥80 years received adjuvant therapies. In the absence of any adjustment of results, the overall survival in women ≥80 years was poorer than in younger patients (median of 14.1 years for <80y vs. 5.7 years for ≥80y), the crude HR was 4.6 (95% CI: 2.9-7.5) p < 0.001. For second survival analysis, the HR was 2.5 (95% CI: 1.8-3.5) p < 0.001. After the third adjustment the HR was 1.7 (95% CI: 1.2-2.4) p = 0.004. CONCLUSIONS Octogenarians with operable breast cancer are receiving suboptimal treatments, which can have repercussions on survival. New studies are required to identify a subgroup of women age ≥80 years who may benefit from more aggressive treatment and a population of older women on the basis of tumor characteristics, comorbidities and life expectancy who may not need as aggressive treatment.
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Affiliation(s)
| | | | | | | | - Pedro Menor-Duran
- General and Digestive Surgery Dept, Castellon General Hospital, Spain
| | - Javier Escrig-Sos
- General and Digestive Surgery Dept, Castellon General Hospital, Spain
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203
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Harrison J, Friese C, Barton D, Janz N, Pressler S, Davis M. Heart Failure and Long-Term Survival Among Older Women With Breast Cancer. Oncol Nurs Forum 2018. [DOI: 10.1188/18.onf.77-87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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204
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Park JH, Choi IS, Kim KH, Kim JS, Lee KH, Kim TY, Im SA, Kim SH, Kim YJ, Kim JH. Treatment Patterns and Outcomes in Elderly Patients with Metastatic Breast Cancer: A Multicenter Retrospective Study. J Breast Cancer 2017; 20:368-377. [PMID: 29285042 PMCID: PMC5743997 DOI: 10.4048/jbc.2017.20.4.368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/06/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose Currently, there is little information regarding optimal treatment for metastatic breast cancer (MBC) in elderly patients. In this retrospective study, we examined a cohort of elderly patients with MBC receiving a range of treatments, in terms of demographic and clinicopathologic characteristics, treatment patterns, and outcomes. Methods Patients aged 65 years and older, and diagnosed with MBC between 2003 and 2015, were identified from the databases of three academic hospitals in South Korea. A total of 161 cases were eligible for inclusion. We assessed clinicopathologic features, treatment patterns, and outcomes, using the available electronic medical records. Based on age at MBC diagnosis, patients were divided into three groups: 65 to 69, 70 to 74, and ≥75 years. Results Most patients had received active treatment according to biologic subtype as in younger patients, although frequent dose modifications were observed during chemotherapy. The median overall survival (OS) for all patients was 30.3 months; age (≥70 years), Eastern Cooperative Oncology Group (ECOG) performance status (PS) (≥2), triple-negative cancer, and number of metastatic sites (≥2) were significant poor prognostic factors for OS in multivariate analyses. All types of systemic treatments according to biologic subtype conferred more prolonged OS in patients receiving treatment. Patients aged ≥75 years were more likely to have a poor ECOG PS and advanced comorbidity, and tended to receive less intensive treatments compared to the other age groups. Conclusion Elderly patients with MBC should not be excluded from receiving standard treatments prescribed for younger patients. Future research plans for elderly patients, especially aged ≥75 years with breast cancer, should include a geriatric assessment for identifying individuals at risk for treatment-related toxicity. Overall, this analysis will provide a better understanding of this population and help guide clinical care in real-world practice.
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Affiliation(s)
- Jin Hyun Park
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Hwan Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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205
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Hall PS, Smith A, Hulme C, Vargas-Palacios A, Makris A, Hughes-Davies L, Dunn JA, Bartlett JMS, Cameron DA, Marshall A, Campbell A, Macpherson IR, Francis A, Earl H, Morgan A, Stein RC, McCabe C. Value of Information Analysis of Multiparameter Tests for Chemotherapy in Early Breast Cancer: The OPTIMA Prelim Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1311-1318. [PMID: 29241890 DOI: 10.1016/j.jval.2017.04.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 04/19/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Precision medicine is heralded as offering more effective treatments to smaller targeted patient populations. In breast cancer, adjuvant chemotherapy is standard for patients considered as high-risk after surgery. Molecular tests may identify patients who can safely avoid chemotherapy. OBJECTIVES To use economic analysis before a large-scale clinical trial of molecular testing to confirm the value of the trial and help prioritize between candidate tests as randomized comparators. METHODS Women with surgically treated breast cancer (estrogen receptor-positive and lymph node-positive or tumor size ≥30 mm) were randomized to standard care (chemotherapy for all) or test-directed care using Oncotype DX™. Additional testing was undertaken using alternative tests: MammaPrintTM, PAM-50 (ProsignaTM), MammaTyperTM, IHC4, and IHC4-AQUA™ (NexCourse Breast™). A probabilistic decision model assessed the cost-effectiveness of all tests from a UK perspective. Value of information analysis determined the most efficient publicly funded ongoing trial design in the United Kingdom. RESULTS There was an 86% probability of molecular testing being cost-effective, with most tests producing cost savings (range -£1892 to £195) and quality-adjusted life-year gains (range 0.17-0.20). There were only small differences in costs and quality-adjusted life-years between tests. Uncertainty was driven by long-term outcomes. Value of information demonstrated value of further research into all tests, with Prosigna currently being the highest priority for further research. CONCLUSIONS Molecular tests are likely to be cost-effective, but an optimal test is yet to be identified. Health economics modeling to inform the design of a randomized controlled trial looking at diagnostic technology has been demonstrated to be feasible as a method for improving research efficiency.
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Affiliation(s)
- Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Alison Smith
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Armando Vargas-Palacios
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andreas Makris
- Department of Clinical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, UK
| | - Luke Hughes-Davies
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David A Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Andrea Marshall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy Campbell
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iain R Macpherson
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Adele Francis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Helena Earl
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Robert C Stein
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
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206
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Real-world treatment in patients with HER2+ metastatic breast cancer : Treatment decisions in HER2+ mBC. Breast Cancer Res Treat 2017; 168:197-205. [PMID: 29170976 PMCID: PMC5847072 DOI: 10.1007/s10549-017-4567-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
Abstract
Purpose The landscape of HER2+ metastatic breast cancer (mBC) treatment is changing due to the availability of new anti-HER2 drugs. The purpose of this study was to assess the current treatment patterns and sequences used in HER2+ mBC in the real-world setting. Secondary objectives were to describe the factors that influence the decision to prescribe a first and second-line antitumour treatment. Methods Retrospective chart review of 3068 cases in Spain, Italy, the Netherlands and the UK. Results First and second-line treatments and regimens are consistent with the clinical guidelines, especially for recently initiated treatments. Age and performance status (PS) of patients impact treatment patterns: younger patients received more innovative treatments than elderly patients. In addition, while most patients received a first antitumor treatment, the rate of patients who continue to subsequent lines of therapy is low (55% transitioning from 1st to 2nd line; 58% from 2nd to 3rd line). Age and PS are key factors in the decision to prescribe further antitumor treatment. Conclusion Fewer HER2+ mBC patients than expected receive a second and third line therapy. Guidelines should make specific recommendations for older patients or those with a poor PS.
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207
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Lei X, Liu F, Luo S, Sun Y, Zhu L, Su F, Chen K, Li S. Evaluation of guidelines regarding surgical treatment of breast cancer using the AGREE Instrument: a systematic review. BMJ Open 2017; 7:e014883. [PMID: 29138191 PMCID: PMC5695453 DOI: 10.1136/bmjopen-2016-014883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Many clinical practice guidelines and consensus statements (CPGs/consensus statements) have been developed for the surgical treatments for breast cancer. This study aims to evaluate the quality of these CPGs/consensus statements. METHODS We systematically searched the PubMed and EMBASE databases, as well as four guideline repositories, to identify CPGs and consensus statements regarding surgical treatments for breast cancer between January 2009 and December 2016. We used the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument to assess the quality of the CPGs and consensus statements included. The overall assessment scores from the AGREE instrument and radar maps were used to evaluate the overall quality. We also evaluated some factors that may affect the quality of CPGs and consensus statements using the Mann-Whitney U test or Kruskal-Wallis H test. All analyses were performed using SPSS V.19.0. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 19 CPGs and four consensus statements were included. In general, the included CPGs/consensus statements (n=23) performed well in the 'Scope and Purpose' and 'Clarity and Presentation' domains, but performed poorly in the 'Applicability' domain. The American Society of Clinical Oncology (ASCO), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), New Zealand Guidelines Group (NZGG) and Belgium Health Care Knowledge Centre (KCE) guidelines had the highest overall quality, whereas the Saskatchewan Cancer Agency, Spanish Society of Medical Oncology (SEOM), Japanese Breast Cancer Society (JBCS) guidelines and the D.A.C.H and European School of Oncology (ESO) consensus statements had the lowest overall quality. The updating frequency of CPGs/consensus statements varied, with the quality of consensus statements generally lower than that of CPGs. A total of six, eight and five CPGs were developed in the North American, European and Asian/Pacific regions, respectively. However, geographic region was not associated with overall quality. CONCLUSIONS The ASCO, NICE, SIGN, NZGG and KCE guidelines had the best overall quality, and the quality of consensus statements was generally lower than that of CPGs. More efforts are needed to identify barriers and facilitators for CPGs/consensus statement implementation and to improve their applicability.
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Affiliation(s)
- Xin Lei
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Thyroid and Breast SurgeryDepartment, The First AffliatedHospital, Guangzhou, Guangdong, China
| | - Fengtao Liu
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shuying Luo
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Pharmacy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ya Sun
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liling Zhu
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fengxi Su
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Chen
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shunrong Li
- Breast Tumour Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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208
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Mays S, Alabdulkareem H, Christos P, Simmons R, Moo TA. Surgical outcomes in women ≥70 years undergoing mastectomy with and without reconstruction for breast cancer. Am J Surg 2017; 214:904-906. [DOI: 10.1016/j.amjsurg.2017.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/27/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
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209
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Biganzoli L, Marotti L, Hart CD, Cataliotti L, Cutuli B, Kühn T, Mansel RE, Ponti A, Poortmans P, Regitnig P, van der Hage JA, Wengström Y, Rosselli Del Turco M. Quality indicators in breast cancer care: An update from the EUSOMA working group. Eur J Cancer 2017; 86:59-81. [DOI: 10.1016/j.ejca.2017.08.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/07/2017] [Accepted: 08/11/2017] [Indexed: 02/07/2023]
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210
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Pepping RMC, Portielje JEA, van de Water W, de Glas NA. Primary Endocrine Therapy in Older Women with Breast Cancer. CURRENT GERIATRICS REPORTS 2017; 6:239-246. [PMID: 29238654 PMCID: PMC5719125 DOI: 10.1007/s13670-017-0223-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of Review Breast cancer incidence increases with age. In recent years, primary endocrine therapy has been increasingly used as a treatment option for frail elderly women with breast cancer, although surgery is still the guideline-recommended treatment. In this review, we discuss the evidence for primary endocrine therapy versus surgical treatment in older women with early breast cancer. Recent Findings Both randomised controlled trials and recent observational studies showed a favourable progression-free survival but not overall survival for surgery plus adjuvant endocrine therapy versus primary endocrine therapy. Information about quality of life with either treatment strategy is so far lacking. Deciding who is fit for surgery and has sufficiently long life expectation to be at risk of disease progression can be supported by performing an individual geriatric assessment. Summary This review suggests that primary endocrine therapy is a reasonable alternative to primary surgery in frail older women with breast cancer. Future studies should focus on the long-term effects on quality of life and physical functioning.
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Affiliation(s)
- R M C Pepping
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.,Department of Clinical Oncology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - W van de Water
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - N A de Glas
- Department of Clinical Oncology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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211
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Honecker F, Harbeck N, Schnabel C, Wedding U, Waldenmaier D, Saupe S, Jäger E, Schmidt M, Kreienberg R, Müller L, Otremba B, Dorn J, Warm M, Al-Batran SE, de Wit M. Geriatric assessment and biomarkers in patients with metastatic breast cancer receiving first-line mono-chemotherapy: Results from the randomized phase III PELICAN trial. J Geriatr Oncol 2017; 9:163-169. [PMID: 29055624 DOI: 10.1016/j.jgo.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 08/23/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine predictive/prognostic factors for patients with metastatic breast cancer (MBC) receiving first-line monochemotherapy using biomarker analysis and geriatric assessment (GA). MATERIALS AND METHODS Karnofsky Performance Status (KPS) and GA as clinical parameters, and prognostic inflammatory and nutritional index (PINI), and Glasgow prognostic score (GPS) as biomarkers were analyzed for association with clinical outcome within the randomized phase III PEg-LIposomal Doxorubicin vs. CApecitabin iN MBC (PELICAN) trial of first-line pegylated liposomal doxorubicin (PLD) or capecitabine. RESULTS Of 210 patients, 38% were >65years old. GA (n=152) classified 74% as fit, 10% as compromised, and 16% as frail. Biomarkers showed no age dependency. In multivariate analysis (n=70) KPS, GA, cumulative illness rating scale-geriatrics (CIRS-G), and GPS were significantly associated with time to progression, and KPS, CIRS-G, and instrumental activities of daily living (IADL) from GA, and PINI showed a significant correlation with overall survival. CONCLUSION GA evaluation was feasible. KPS significantly correlated with efficacy outcomes. Items of a GA and biomarkers of inflammation and nutrition may have prognostic significance in patients with MBC.
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Affiliation(s)
- Friedemann Honecker
- Department of Oncology/Hematology/Pneumology, University Medical Center Eppendorf, Martinitrasse 52, 20246 Hamburg, Germany; Tumor and Breast Center ZeTuP St. Gallen, Rorschacher Strasse 150, 9006 St. Gallen, Switzerland.
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Claudia Schnabel
- Metabolic Laboratory and Newborn Screening, University Medical Center Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Ulrich Wedding
- Internal Medicine Clinic II, Department of Palliative Care, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany.
| | | | - Steffen Saupe
- Department of Obstetrics and Gynecology, Technical University of Munich, Arcisstrasse 21, 80333 Munich, Germany.
| | - Elke Jäger
- Oncology and Hematology, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany.
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Saarstrasse 21, 55122 Mainz, Germany.
| | - Rolf Kreienberg
- Universitätsfrauenklinik, Prittwitzstrasse 43, 89081 Ulm, Germany.
| | - Lothar Müller
- Onkologische Schwerpunktpraxis, Annenstrasse 11, 26789 Leer, Germany.
| | - Burkhard Otremba
- Onkologische Praxis Oldenburg, Grüne Strasse, 26121 Oldenburg, Germany.
| | - Julia Dorn
- Department of Obstetrics and Gynecology, Technical University of Munich, Arcisstrasse 21, 80333 Munich, Germany.
| | - Mathias Warm
- Brustzentrum, Krankenhaus Köln-Holweide, Neufelder Strasse 32, 51067 Cologne, Germany.
| | - Salah-Eddin Al-Batran
- Oncology and Hematology, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany.
| | - Maike de Wit
- Vivantes Klinikum Neukoelln, Rudower Strasse 48, 12351 Berlin, Germany.
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Brodowicz T, Hadji P, Niepel D, Diel I. Early identification and intervention matters: A comprehensive review of current evidence and recommendations for the monitoring of bone health in patients with cancer. Cancer Treat Rev 2017; 61:23-34. [PMID: 29100167 DOI: 10.1016/j.ctrv.2017.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022]
Abstract
Bone metastases are common in patients with advanced solid tumors, and many individuals experience debilitating skeletal-related events (SREs; e.g. pathologic fracture, hypercalcemia, radiotherapy or surgery to bone, and spinal cord compression). These events substantially affect disease outcomes, including survival and quality of life, and healthcare systems. Plain radiography is the most widely used imaging modality for the detection of bone metastases; skeletal scintigraphy, computed tomography, positron emission tomography and magnetic resonance imaging offer greater sensitivity but their use in routine practice is restricted by high costs and limited availability. Biomarkers of bone turnover may also have a role in the early detection of bone metastases and can provide valuable prognostic information on disease progression. SREs can be delayed or prevented using agents such as the receptor activator of nuclear factor kappa B ligand (RANKL) inhibitor, denosumab, and bisphosphonates. Painful bone metastases can be treated with radiofrequency ablation, radiotherapy, or radionuclides such as radium-223 dichloride, which has been shown to delay the onset of SREs in men with castration-resistant prostate cancer. Close monitoring of bone health in patients with advanced cancer may lead to early identification of individuals with bone metastases who could benefit from early intervention to prevent SREs. This review examines current guideline recommendations for assessing and monitoring bone health in patients with advanced cancer, use of biomarkers and treatment of patients with bone metastases. The emerging evidence for the potential survival benefit conferred by early intervention with denosumab and bisphosphonates is also discussed, together with best practice recommendations.
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Affiliation(s)
- Thomas Brodowicz
- Department of Medicine I and Comprehensive Cancer Center, Clinical Division of Oncology, Medical University of Vienna, General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Peyman Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Northwest Hospital, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany; Philipps-University of Marburg, Biegenstraße 10, 35037 Marburg, Germany.
| | - Daniela Niepel
- Amgen (GmbH) Europe, Dammstrasse 23, 6300 Zug, Switzerland.
| | - Ingo Diel
- Center for Comprehensive Gynecology, Augustaanlage 7-11, 68165 Mannheim, Germany.
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213
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Thomas R, Pieri A, Cain H. A systematic review of generic and breast cancer specific life expectancy models in the elderly. Eur J Surg Oncol 2017; 43:1816-1827. [DOI: 10.1016/j.ejso.2017.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/05/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022] Open
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214
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Lee CM, Zheng H, Tan VKM, Tan TJY, Kanesvaran R, Wong FY, Sim YR, Yong WS, Madhukumar P, Ong KW, Tan BKT. Surgery for early breast cancer in the extremely elderly leads to improved outcomes - An Asian population study. Breast 2017; 36:44-48. [PMID: 28942237 DOI: 10.1016/j.breast.2017.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/11/2017] [Accepted: 09/11/2017] [Indexed: 11/26/2022] Open
Abstract
AIM The optimal treatment of breast cancer for extremely elderly patients (aged ≥ 80 years) is debatable. With an aging population, management of this group of patients will be increasingly common. This study aims to compare the survival outcomes of extremely elderly patients against younger ones, following different treatment modalities within each stage. The differences in treatment patterns across different stages have also been examined. METHODS Female Singapore Citizens and Permanent Residents diagnosed with breast cancer from 2003 to 2014 were identified from the Singapore Cancer Registry. Patients were divided into 2 age groups, below 80, and 80 and above years old, and categorized into 3 main treatment groups, namely surgery, non-surgical treatment, and no treatment. Analysis was made on their survival outcomes. RESULTS 19,314 patients were diagnosed with breast cancer during the 12-year study period. 1482 patients were excluded due to unknown stage. 673 patients were aged 80 years and above, while 17,159 patients were aged below 80. Elderly patients presented with later stages of disease, and were less likely to have surgery. In Stage I and II, the difference in 5-year breast cancer specific outcome following surgery, was small between the 2 age groups. Among the elderly group, surgery resulted in improved survival. Those who did not have surgery performed better with endocrine therapy than with no treatment. CONCLUSIONS Extremely elderly patients, especially those with Stages I and II breast cancer do not fare worse than younger patients, and should be offered surgery if they are fit.
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Affiliation(s)
- Chee Meng Lee
- Department of General Surgery, Academia, 20 College Road, 169856, Singapore
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, 3 Second Hospital Avenue, Level 5, 168937, Singapore
| | - Veronique Kiak-Mien Tan
- Department of General Surgery, Academia, 20 College Road, 169856, Singapore; Singhealth-Duke NUS Breast Centre, Academia, 20 College Road, 169856, Singapore; National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore
| | | | | | - Fuh-Yong Wong
- National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore
| | - Yi Rong Sim
- Department of General Surgery, Academia, 20 College Road, 169856, Singapore; Singhealth-Duke NUS Breast Centre, Academia, 20 College Road, 169856, Singapore; National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore
| | - Wei Sean Yong
- Department of General Surgery, Academia, 20 College Road, 169856, Singapore; Singhealth-Duke NUS Breast Centre, Academia, 20 College Road, 169856, Singapore; National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore
| | - Preetha Madhukumar
- Department of General Surgery, Academia, 20 College Road, 169856, Singapore; Singhealth-Duke NUS Breast Centre, Academia, 20 College Road, 169856, Singapore; National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore
| | - Kong Wee Ong
- Department of General Surgery, Academia, 20 College Road, 169856, Singapore; Singhealth-Duke NUS Breast Centre, Academia, 20 College Road, 169856, Singapore; National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore
| | - Benita Kiat-Tee Tan
- Department of General Surgery, Academia, 20 College Road, 169856, Singapore; Singhealth-Duke NUS Breast Centre, Academia, 20 College Road, 169856, Singapore; National Cancer Centre Singapore, 11 Hospital Drive, 169610, Singapore.
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215
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Park NJ, Chang Y, Bender C, Conley Y, Chlebowski RT, van Londen GJ, Foraker R, Wassertheil-Smoller S, Stefanick ML, Kuller LH. Cardiovascular disease and mortality after breast cancer in postmenopausal women: Results from the Women's Health Initiative. PLoS One 2017; 12:e0184174. [PMID: 28934233 PMCID: PMC5608205 DOI: 10.1371/journal.pone.0184174] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/19/2017] [Indexed: 11/19/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among older postmenopausal women. The impact of postmenopausal breast cancer on CVD for older women is uncertain. We hypothesized that older postmenopausal women with breast cancer would be at a higher risk of CVD than similar aged women without breast cancer and that CVD would be a major contributor to the subsequent morbidity and mortality. Methods In a prospective Women’s Health Initiative study, incident CVD events and total and cause-specific death rates were compared between postmenopausal women with (n = 4,340) and without (n = 97,576) incident invasive breast cancer over 10 years post-diagnosis, stratified by 3 age groups (50–59, 60–69, and 70–79). Results Postmenopausal women, regardless of breast cancer diagnosis, had similar and high levels of CVD risk factors (e.g., smoking and hypertension) at baseline prior to breast cancer, which were strong predictors of CVD and total mortality over time. CVD affected mostly women age 70–79 with localized breast cancer (79% of breast cancer cases in 70–79 age group): only 17% died from breast cancer and CVD was the leading cause of death (22%) over the average 10 years follow up. Compared to age-matched women without breast cancer, women age 70–79 at diagnosis of localized breast cancer had a similar multivariate-adjusted hazard ratio (HR) of 1.01 (95% confidence interval [CI]: 0.76–1.33) for coronary heart disease, a lower risk of composite CVD (HR = 0.84, 95% CI: 0.70–1.00), and a higher risk of total mortality (HR = 1.20, 95% CI: 1.04–1.39). Conclusion CVD was a major contributor to mortality in women with localized breast cancer at age 70–79. Further studies are needed to evaluate both screening and treatment of localized breast cancer tailored to the specific health issues of older women.
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Affiliation(s)
- Na-Jin Park
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Yuefang Chang
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Catherine Bender
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Rowan T. Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - G. J. van Londen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Randi Foraker
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Lewis H. Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Hamelinck VC, Bastiaannet E, Pieterse AH, Merkus JWS, Jannink I, den Hoed IDM, van de Velde CJH, Liefers GJ, Stiggelbout AM. A prospective comparison of younger and older patients' preferences for breast-conserving surgery versus mastectomy in early breast cancer. J Geriatr Oncol 2017; 9:170-173. [PMID: 28919022 DOI: 10.1016/j.jgo.2017.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/23/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Victoria C Hamelinck
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos W S Merkus
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Ilse Jannink
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Irma D M den Hoed
- Department of Surgery, TweeSteden Hospital, Tilburg, The Netherlands
| | | | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
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217
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Thomas R, Rowell R, Crichton S, Cain H. An observational study investigating failure of primary endocrine therapy for operable breast cancer in the elderly. Breast Cancer Res Treat 2017; 167:73-80. [PMID: 28879429 DOI: 10.1007/s10549-017-4494-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Elderly patients are more likely to have oestrogen receptor positive cancers that can be treated without surgery with primary endocrine therapy (PET). Few studies have sought to identify predictors of failure of PET and so the aim of this study was to evaluate treatment failures in elderly breast cancer patients treated with PET and to determine predictors of failure. METHODS A retrospective observational study was performed on consecutive patients with ER-positive early stage breast cancer treated with PET between 2005 and 2015 in the three breast units in the North East of England. The primary outcome measure was treatment failure and secondary outcome measure was disease progression. RESULTS 488 patients were included with mean follow-up 31 months (SD 23). Overall, 206 patients were still alive with their disease controlled at the end of follow-up, 219 had died with their disease controlled and 63 (12%) experienced treatment failure. Younger age [SHR 0.96 (95% CI 0.94-0.99) p 0.013], larger tumours [SHR 1.03 (1.01-1.06) p 0.015], grade 3 cancers [SHR 3.58 (1.93-6.63) p < 0.001] and axillary lymph node metastases [SHR 1.93 (1.06-3.52) p 0.030] were all independent predictors of treatment failure. Disease progression was reported in 86 (17.6%) of patients. CONCLUSIONS This is the largest retrospective series evaluating PET treatment failure. Clear predictors of failure have been identified, which can be used to facilitate treatment decision making. These results support previous analyses, further validating our results.
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Affiliation(s)
- Robert Thomas
- Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK. .,, 48 Larkspur Terrace, Jesmond, Newcastle upon Tyne, NE2 2DU, UK.
| | - Rachel Rowell
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Siobhan Crichton
- Medical Research Council Clinical Trials Unit, University College London, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Henry Cain
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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218
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Lobo-Cardoso R, Magalhães AT, Fougo JL. Neoadjuvant endocrine therapy in breast cancer patients. Porto Biomed J 2017; 2:170-173. [PMID: 32258615 PMCID: PMC6806912 DOI: 10.1016/j.pbj.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/25/2017] [Indexed: 11/16/2022] Open
Abstract
HIGHLIGHTS The overall response rate to neoadjuvant endocrine therapy (NET) was 54.55%.The eight patients proposed to tumour's downstage, after 9.71 months of NET, preserved their breast.In the group which achieved response, 10.28 months was the mean time to accomplish it.Even patients who had the worst outcome only began to suffer latter in the course of therapy.NET can be done beyond the conventional 3-4 months to allow additional downstage of the tumour. BACKGROUND The aim of this study is to evaluate if the extension of neoadjuvant endocrine therapy (NET), beyond the conventional time, allows additional downstage of the tumour, in order to perform a breast conservative surgery (BCS), and to analyze if it is a good option for long-term control in patients who refuse or are unfit for surgery. PATIENTS AND METHODS We retrospectively reviewed a database containing all patients treated in our institution with NET. All included patients were post-menopausal with primary local disease. The type of response obtained was assessed using modified RECIST criteria. RESULTS Thirty-three patients were included. Two patients had tumours with 90% expression of oestrogen receptors and all the others had 100%. The tumour size in the largest diameter was 6.51 cm before treatment and 5.18 cm after. Eighteen patients achieved a partial response after 10.28 months of therapy. Patients that were proposed to downstage the tumour performed 9.71 months of therapy until surgery and all were submitted to BCS. Progression occurred after 27.5 months. CONCLUSION Endocrine therapy is a feasible option for a longer time to allow additional downstage of the tumour and is a good solution in patients who refuse or are unfit for surgery.
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Affiliation(s)
| | | | - José Luís Fougo
- Breast Center, General Surgery Service, São João Hospital, Porto, Portugal
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221
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Gion M, Cardinali G, Trevisiol C, Zappa M, Rainato G, Fabricio ASC. Indicators of inappropriate tumour marker use through the mining of electronic health records. J Eval Clin Pract 2017; 23:895-902. [PMID: 28503788 DOI: 10.1111/jep.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Although the issue of monitoring appropriateness of tumour markers (TMs) request in outpatients remains crucial, proper indicators are still demanding. The present study developed and explored indicators of inappropriate TM ordering in outpatients through the data mining of electronic health records (EHRs). METHODS Carcinoembryonic antigen (CEA), alfa-fetoprotein (AFP), carbohydrate antigen (CA)125, CA15.3, CA19.9, and prostate-specific antigen (PSA) ordered in outpatients during a year were examined by mining EHRs of a Local Health Authority in Italy. Evidence-based criteria were used to develop performance indicators. Demographic and clinical information associated with TM orders were examined. RESULTS A total of 80 813 TMs were ordered in 52 536 outpatients (1.54 markers/patient). Indicators related to disease codes, gender, age, and TM repetitions were developed, and their application showed that (1) CA15.3 and CEA are prevalently requested in patients with cancer (79.2% and 65.6%) whereas the other TMs are largely requested also in patients without cancer; (2) requests of PSA in women and of CA125 or CA15.3 in men are negligible; (3) although requests in people older than 80 years are relevant (16.4% of total), the highest rate of request of all markers occurs in patients aged 40 to 79 years; (4) CA15.3 and CEA are mainly requested in cancer cases between 50 and 79 years and AFP, CA19.9, and CA125 in those between 60 and 69 years; (5) <50% of PSA orders are associated with cancer code for all age intervals; and (6) multiple repetitions of AFP, CA125, CA15.3, CA19.9, and CEA are prevalent in cancer patients or benign diseases to which TMs are appropriate, whereas PSA repetitions occur mainly in patients without cancer. CONCLUSIONS The developed indicators resulted suitable to monitor TM overordering in outpatients through the mining of EHRs. The present study is a first approach towards the use of big-data mining for TM appropriateness evaluation purposes.
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Affiliation(s)
- Massimo Gion
- Centro Regionale Specializzato e Programma Regionale Biomarcatori, AULSS 3 Serenissima, Venice, Italy
| | | | | | - Marco Zappa
- Clinical and Descriptive Epidemiology Unit, ISPO Cancer Research and Prevention Institute, Florence, Italy
| | | | - Aline S C Fabricio
- Centro Regionale Specializzato e Programma Regionale Biomarcatori, AULSS 3 Serenissima, Venice, Italy
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Collins K, Reed M, Lifford K, Burton M, Edwards A, Ring A, Brain K, Harder H, Robinson T, Cheung KL, Morgan J, Audisio R, Ward S, Richards P, Martin C, Chater T, Pemberton K, Nettleship A, Murray C, Walters S, Bortolami O, Armitage F, Leonard R, Gath J, Revell D, Green T, Wyld L. Bridging the age gap in breast cancer: evaluation of decision support interventions for older women with operable breast cancer: protocol for a cluster randomised controlled trial. BMJ Open 2017; 7:e015133. [PMID: 28760787 PMCID: PMC5642653 DOI: 10.1136/bmjopen-2016-015133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION While breast cancer outcomes are improving steadily in younger women due to advances in screening and improved therapies, there has been little change in outcomes among the older age group. It is inevitable that comorbidities/frailty rates are higher, which may increase the risks of some breast cancer treatments such as surgery and chemotherapy, many older women are healthy and may benefit from their use. Adjusting treatment regimens appropriately for age/comorbidity/frailty is variable and largely non-evidence based, specifically with regard to rates of surgery for operable oestrogen receptor-positive disease and rates of chemotherapy for high-risk disease. METHODS AND ANALYSIS This multicentre, parallel group, pragmatic cluster randomised controlled trial (RCT) (2015-18) reported here is nested within a larger ongoing 'Age Gap Cohort Study' (2012-18RP-PG-1209-10071), aims to evaluate the effectiveness of a complex intervention of decision support interventions to assist in the treatment decision making for early breast cancer in older women. The interventions include two patient decision aids (primary endocrine therapy vs surgery/antioestrogen therapy and chemotherapy vs no chemotherapy) and a clinical treatment outcomes algorithm for clinicians. ETHICS AND DISSEMINATION National and local ethics committee approval was obtained for all UK participating sites. Results from the trial will be submitted for publication in international peer-reviewed scientific journals. IRAS REFERENCE 115550. TRIAL REGISTRATION NUMBER European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2015-004220-61;Pre-results. Sponsor's Protocol Code Number Sheffield Teaching Hospitals STH17086. ISRCTN 32447*.
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Affiliation(s)
- Karen Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Katherine Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Thompson Robinson
- Department of Cardiovascular Sciences, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Nottingham, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Susan Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anthony Nettleship
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher Murray
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Oscar Bortolami
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Jacqui Gath
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Deirdre Revell
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Tracy Green
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
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Fiorentino A, Mazzola R, Giaj Levra N, Fersino S, Ricchetti F, Di Paola G, Gori S, Massocco A, Alongi F. Comorbidities and intensity-modulated radiotherapy with simultaneous integrated boost in elderly breast cancer patients. Aging Clin Exp Res 2017; 30:533-538. [DOI: 10.1007/s40520-017-0802-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/14/2017] [Indexed: 12/11/2022]
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Treatment recommendations for older women with breast cancer: A survey among surgical, radiation and medical oncologists. Eur J Surg Oncol 2017; 43:1288-1296. [DOI: 10.1016/j.ejso.2017.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/11/2017] [Accepted: 02/04/2017] [Indexed: 11/19/2022] Open
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225
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Evaluating the association between adjuvant chemotherapy and function-related adverse events among older patients with early stage breast cancer. J Geriatr Oncol 2017; 8:242-248. [DOI: 10.1016/j.jgo.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/04/2017] [Accepted: 05/24/2017] [Indexed: 11/19/2022]
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226
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Abstract
The incidence of brain tumors in the elderly population has increased over the last few decades. Current treatment includes surgery, radiotherapy and chemotherapy, but the optimal management of older patients with brain tumors remains a matter of debate, since aggressive radiation treatments in this population may be associated with high risks of neurological toxicity and deterioration of quality of life. For such patients, a careful clinical status assessment is mandatory both for clinical decision making and for designing randomized trials to adequately evaluate the optimal combination of radiotherapy and chemotherapy. Several randomized studies have demonstrated the efficacy and safety of chemotherapy for patients with glioblastoma or lymphoma; however, the use of radiotherapy given in association with chemotherapy or as salvage therapy remains an effective treatment option associated with survival benefit. Stereotactic techniques are increasingly used for the treatment of patients with brain metastases and benign tumors, including pituitary adenomas, meningiomas and acoustic neuromas. Although no randomized trials have proven the superiority of SRS over other radiation techniques in older patients with brain metastases or benign brain tumors, data extracted from recent randomized studies and large retrospective series suggest that SRS is an effective approach in such patients associated with survival advantages and toxicity profile similar to those observed in young adults. Future trials need to investigate the optimal radiation techniques and dose/fractionation schedules in older patients with brain tumors with regard to clinical outcomes, neurocognitive function, and quality of life.
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Affiliation(s)
- Giuseppe Minniti
- Department of Neurological Sciences, IRCCS Neuromed, Via Atinense, Pozzilli, (IS), Italy. .,UPMC San Pietro FBF, Radiotherapy Center, Rome, Italy.
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227
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Controversial issues in the management of older adults with early breast cancer. J Geriatr Oncol 2017; 8:397-402. [PMID: 28602710 DOI: 10.1016/j.jgo.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/05/2017] [Accepted: 05/24/2017] [Indexed: 12/12/2022]
Abstract
It is well recognized that the incidence of breast cancer increases significantly with age. Despite this, older people remain under-represented in many clinical trials and their management relies on extrapolation of data from younger patients. Providing an aggressive intervention can be challenging, particularly in less fit older patients where a conservative approach is commonly perceived to be more appropriate. The optimal management of this population is unknown and treatment decision should be personalized. This review article will discuss several controversial issues in managing older adults with early breast cancer in a multidisciplinary setting, including the role of surgical treatment of the axilla in clinically node negative disease, radiotherapy after breast conservation surgery in low-risk tumours, personalizing adjuvant systemic therapy, and geriatric assessments in breast cancer treatment decisions.
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Breast cancer electron intraoperative radiotherapy: assessment of preoperative selection factors from a retrospective analysis of 758 patients and review of literature. Breast Cancer Res Treat 2017; 165:261-271. [DOI: 10.1007/s10549-017-4321-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/29/2017] [Indexed: 11/25/2022]
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230
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Torisson G, Stavenow L, Minthon L, Londos E. Importance and added value of functional impairment to predict mortality: a cohort study in Swedish medical inpatients. BMJ Open 2017; 7:e014464. [PMID: 28566362 PMCID: PMC5730010 DOI: 10.1136/bmjopen-2016-014464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Accurate estimation of prognosis in multimorbid hospital patients could improve quality of care. This study aims to determine the relative importance and added value of a performance-based activities of daily living (ADL) measure with regard to mortality prediction. METHODS 200 inpatients, aged over 60 years, were recruited at the Department of General Internal Medicine at a tertiary university hospital. Two nested survival models were built, one with established risk factors (age, sex, Charlson comorbidity index, haemoglobin, albumin, body mass index and glomerular filtration rate), and one using the same covariates with the Gottfries-Bråne-Steen (GBS)-ADL measure added. The relative importance of GBS-ADL was evaluated in the full model. The added value of GBS-ADL was determined by comparing the nested models using four approaches: difference in overall χ2, discrimination, continuous net reclassification index (NRI >0) and integrated discrimination improvement (IDI). RESULTS In the full model, GBS-ADL was the single most important predictor of mortality (χ2-df=30, p<0.001). The likelihood ratio χ2 test showed significant added value of ADL (p<0.001). The C-statistic was 0.78 with ADL and 0.72 without (difference 0.058, 95% CI 0.022 to 0.094). The NRI >0 was 0.42 (95% CI 0.20 to 0.58) and IDI 0.15 (95% CI 0.07 to 0.22). CONCLUSIONS Compared with a set of available clinical risk factors, impairment in ADL was a stronger predictor of all-cause mortality, showing substantial added value. Implementing quantitative ADL measurements could enable more appropriate and individual care for the elderly.
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Affiliation(s)
- Gustav Torisson
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Lars Stavenow
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
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231
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Methodology of phase II clinical trials in metastatic elderly breast cancer: a literature review. Breast Cancer Res Treat 2017; 164:505-513. [DOI: 10.1007/s10549-017-4278-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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232
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Tamoxifen with radiotherapy compared with Tamoxifen alone in elderly women with early-stage breast cancer treated with breast conserving surgery: A systematic review and meta-analysis. Radiother Oncol 2017; 123:1-9. [DOI: 10.1016/j.radonc.2017.02.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 12/23/2022]
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233
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Hornova J, Bortlicek Z, Majkova P, Abrahamova J, Kordikova D, Donatova Z, Kupec M, Boublikova L, Dvorak J, Zapletal R, Buchler T. Locally advanced breast cancer in elderly patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:217-222. [PMID: 28360434 DOI: 10.5507/bp.2017.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/17/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although locally advanced breast cancer (LABC) is more common in the elderly population, there is little data on the clinical characteristics and survival of these patients. The aim of the present study was to compare different factors affecting survival in elderly patients with LABC. METHODS Retrospective analysis was carried out on a cohort of 80 patients aged 70 to 96 years, diagnosed with LABC defined as T3 N1, T4 N0, any N2 or N3, and M0. The prognostic impact of selected clinical parameters including age, comorbidities, tumour grade, HER2 status, tumour stage, local therapies, and systemic treatments was studied. RESULTS The median age of the patients was 79 years. The majority (n=53; 66%) had at least one significant comorbidity according to the Charlson score evaluation. The median overall survival was 50.6 months. As expected, hormonal therapy was the dominant mode of systemic treatment, but 24% also received at least one line of chemotherapy. Local therapies including surgery and/or radiotherapy were applied in 58% of patients. CONCLUSIONS The diagnosis of LABC in the elderly is associated with poor prognosis. Age and serious comorbidities were negative prognostic factors.
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Affiliation(s)
- Jana Hornova
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Zbynek Bortlicek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Petra Majkova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Jitka Abrahamova
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Drahomira Kordikova
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Zuzana Donatova
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Martin Kupec
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Ludmila Boublikova
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Josef Dvorak
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Radek Zapletal
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Tomas Buchler
- Department of Oncology, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
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Abstract
Breast cancer is one of the three most common cancers worldwide. Early breast cancer is considered potentially curable. Therapy has progressed substantially over the past years with a reduction in therapy intensity, both for locoregional and systemic therapy; avoiding overtreatment but also undertreatment has become a major focus. Therapy concepts follow a curative intent and need to be decided in a multidisciplinary setting, taking molecular subtype and locoregional tumour load into account. Primary conventional surgery is not the optimal choice for all patients any more. In triple-negative and HER2-positive early breast cancer, neoadjuvant therapy has become a commonly used option. Depending on clinical tumour subtype, therapeutic backbones include endocrine therapy, anti-HER2 targeting, and chemotherapy. In metastatic breast cancer, therapy goals are prolongation of survival and maintaining quality of life. Advances in endocrine therapies and combinations, as well as targeting of HER2, and the promise of newer targeted therapies make the prospect of long-term disease control in metastatic breast cancer an increasing reality.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany.
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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235
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Omission of axillary staging in elderly patients with early stage breast cancer impacts regional control but not survival: A systematic review and meta-analysis. J Geriatr Oncol 2017; 8:140-147. [DOI: 10.1016/j.jgo.2016.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/11/2016] [Accepted: 12/01/2016] [Indexed: 12/24/2022]
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236
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Bailur JK, Pawelec G, Hatse S, Brouwers B, Smeets A, Neven P, Laenen A, Wildiers H, Shipp C. Immune profiles of elderly breast cancer patients are altered by chemotherapy and relate to clinical frailty. Breast Cancer Res 2017; 19:20. [PMID: 28241844 PMCID: PMC5330012 DOI: 10.1186/s13058-017-0813-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/06/2017] [Indexed: 01/12/2023] Open
Abstract
Background Effective therapeutic management of elderly patients with cancer, on an individual basis, remains a clinical challenge. Here, we identify novel biomarkers to assess elderly patients (≥70 years of age) with breast cancer undergoing treatment with or without chemotherapy. Methods We performed comprehensive geriatric assessment and measured markers sensitive to alteration in ageing, including leukocyte telomere length, CMV serostatus, levels of circulating growth factors and cytokines, and immune profiling of T cell and myeloid populations in blood before and at 3 months and 12 months after initiation of therapy, using flow cytometry. Results We observed changes in immune profiles over time that were specific to patients receiving chemotherapy; these patients had elevated CD4+ T effector memory re-expressing CD45RA (TEMRA) cells and relatively lower CD8+ central memory cells at 3 months, with normalized levels after 12 months. Patients’ baseline immune profiles correlated with markers such as telomere length, cytomegalovirus (CMV) serostatus and levels of circulating cytokines. We also identified correlations between baseline immune profile and geriatric assessment, i.e. more frail patients had higher levels of granulocytic cells but lower levels of cells with suppressor phenotypes including myeloid-derived suppressor cells and regulatory T cells, although none of the examined immune populations correlated with chronological age. Importantly, immune profiles prior to therapy predicted unexpected hospitalizations in patients receiving chemotherapy. Conclusion These findings suggest that immune profiling may represent a novel complementary approach to more accurately assess the global health status of the elderly patient with breast cancer and select the most appropriate individual treatment option. Trial registration ClinicalTrials.gov, NCT00849758. Registered on 20 February 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0813-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jithendra Kini Bailur
- Department of Internal Medicine II, University Hospital Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany.,Present: Yale Cancer Center, Yale University School of Medicine, New Haven, 06510, CT, USA
| | - Graham Pawelec
- Department of Internal Medicine II, University Hospital Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany
| | - Sigrid Hatse
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Barbara Brouwers
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Ann Smeets
- Leuven Multidisciplinary Breast Center, University Hospital Leuven, Leuven, Belgium
| | - Patrick Neven
- Leuven Multidisciplinary Breast Center, University Hospital Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Hans Wildiers
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium.,Department of General Medical Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium.,Leuven Multidisciplinary Breast Center, University Hospital Leuven, Leuven, Belgium
| | - Christopher Shipp
- Department of Internal Medicine II, University Hospital Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany.
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Screening-relevant age threshold of 70 years and older is a stronger determinant for the choice of adjuvant treatment in breast cancer patients than tumor biology. Breast Cancer Res Treat 2017; 163:119-130. [PMID: 28205042 PMCID: PMC5387012 DOI: 10.1007/s10549-017-4151-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/07/2017] [Indexed: 12/21/2022]
Abstract
Purpose The 70-year threshold determines whether patients are eligible or not for the breast cancer screening program in Germany. It is not known whether this age threshold also influences the choice of adjuvant treatment and ultimate outcome. Methods 3463 patients were analyzed from the clinical cancer registry Regensburg (Germany) with primary, non-metastatic invasive breast cancer diagnosed between 2000 and 2012. The distribution of tumor biological subtypes was evaluated in breast cancer patients both in those eligible for screening (ESG, 50–69 years) and those not eligible for screening (NESG, ≥70 years). Local and systemic therapies in different subtypes as well as overall survival (OS) were analyzed. Results 2171 patients (62.7%) pertained to the ESG and 1292 patients (37.3%) referred to the NESG. The distribution of the common subtypes Luminal A, Luminal B, HER2-like, and Basal-like was comparable in both groups. Treatment varied considerably with less systemic therapies in all subtypes in patients in the NESG. Regarding local therapies, patients in the NESG also received less surgery and less radiotherapy. As to Luminal A patients, best OS was seen in patients receiving endocrine therapy (ET) (7-year OS of 95.6%) and CHT plus ET (7-year OS of 93.1%) in the ESG. In the NESG, best OS was seen in patients receiving CHT plus ET (7-year OS of 95.2%), whereas patients receiving only ET had a 7-year OS of 73.9%. Conclusions Despite similar tumor biology, elderly patients are undertreated regarding both systemic and local therapies compared to younger patients, leading to reduced OS.
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238
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Morgan JL, Walters SJ, Collins K, Robinson TG, Cheung KL, Audisio R, Reed MW, Wyld L. What influences healthcare professionals' treatment preferences for older women with operable breast cancer? An application of the discrete choice experiment. Eur J Surg Oncol 2017; 43:1282-1287. [PMID: 28237423 DOI: 10.1016/j.ejso.2017.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/14/2016] [Accepted: 01/08/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Primary endocrine therapy (PET) is used variably in the UK as an alternative to surgery for older women with operable breast cancer. Guidelines state that only patients with "significant comorbidity" or "reduced life expectancy" should be treated this way and age should not be a factor. METHODS A Discrete Choice Experiment (DCE) was used to determine the impact of key variables (patient age, comorbidity, cognition, functional status, cancer stage, cancer biology) on healthcare professionals' (HCP) treatment preferences for operable breast cancer among older women. Multinomial logistic regression was used to identify associations. RESULTS 40% (258/641) of questionnaires were returned. Five variables (age, co-morbidity, cognition, functional status and cancer size) independently demonstrated a significant association with treatment preference (p < 0.05). Functional status was omitted from the multivariable model due to collinearity, with all other variables correlating with a preference for operative treatment over no preference (p < 0.05). Only co-morbidity, cognition and cancer size correlated with a preference for PET over no preference (p < 0.05). CONCLUSION The majority of respondents selected treatment in accordance with current guidelines, however in some scenarios, opinion was divided, and age did appear to be an independent factor that HCPs considered when making a treatment decision in this population.
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Affiliation(s)
- J L Morgan
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - S J Walters
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BA, UK
| | - T G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, P.O. Box 65, Leicester, LE2 7LX, UK
| | - K-L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT, UK
| | - R Audisio
- Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens, WA9 3DA, UK
| | - M W Reed
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK
| | - L Wyld
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
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239
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External radiotherapy for breast cancer in the elderly. Aging Clin Exp Res 2017; 29:149-157. [PMID: 27837457 DOI: 10.1007/s40520-016-0655-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy amongst elderly women and the main cause of mortality. A specific management for elderly woman is not clear because clinical trials are usually not customized for this subset of patients. AIMS The aim of this paper is to provide an overview of the available information on the main issues in the field of breast cancer radiotherapy in the elderly population. MATERIALS AND METHODS Authors discuss on different radiation treatments for breast cancer in the elderly, based on the data of the literature with a focus on new strategy: hypo-fractionation, accelerated partial breast irradiation, and the utility of a dose boost. DISCUSSION The treatment of breast cancer is not standardized in the elderly. The optimal management in this population often requires complex multidisciplinary supportive care due to multiple comorbidities to optimize their cancer care. CONCLUSIONS New options such as APBI or HyRT regimens should be taken into consideration and offered as a breach of duty to the elderly population. Furthermore, they should be extensively investigated through randomized clinical trials.
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240
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Lefeuvre D, Le Bihan-Benjamin C, Pauporté I, Medioni J, Bousquet PJ. French Medico-Administrative Data to Identify the Care Pathways of Women With Breast Cancer. Clin Breast Cancer 2017; 17:e191-e197. [PMID: 28237608 DOI: 10.1016/j.clbc.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Study of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer (BC), at a population level. MATERIALS AND METHODS Women with in situ, local and regional BC who were hospitalized and newly treated in 2012 were included and followed for 1 year. Care pathways were described, focusing on surgery (partial mastectomy [PM], total mastectomy [TM]), chemotherapy, and radiotherapy. The periods of time between treatments were measured and compared with the guidelines. RESULTS The study involved 52,128 women. The most common care pathways among the 2845 women with in situ BC were PM-radiotherapy (46.7%) and TM (28.5%). Among the 41,470 women with local BC, they were: PM-radiotherapy (44.8%) or PM-chemotherapy-radiotherapy (16.0%). The 7813 women with regional BC had similar care pathways, although chemotherapy was given more frequently (73%). The periods of time between surgery and chemotherapy were in accordance with the guidelines for 98% of the women; those between surgery and radiotherapy were affected by adjuvant chemotherapy. Finally, the time between chemotherapy and radiotherapy was longer than recommended for 40% of the women. CONCLUSION The French medicoadministrative databases allow the study, at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary.
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Affiliation(s)
- Delphine Lefeuvre
- Observation, Survey and Assessment Department, Institut National du Cancer, Boulogne-Billancourt, France.
| | | | - Iris Pauporté
- Clinical Trial Department, Institut National du Cancer, Boulogne-Billancourt, France
| | - Jacques Medioni
- Paris Descartes University, Paris, France; Medical Oncology Department, Georges Pompidou European Hospital, Paris, France
| | - Philippe-Jean Bousquet
- Observation, Survey and Assessment Department, Institut National du Cancer, Boulogne-Billancourt, France
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241
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Dellapasqua S. Systemic Treatment for Specific Medical Situations. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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242
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Meresse M, Bouhnik AD, Bendiane MK, Retornaz F, Rousseau F, Rey D, Giorgi R. Chemotherapy in Old Women with Breast Cancer: Is Age Still a Predictor for Under Treatment? Breast J 2016; 23:256-266. [DOI: 10.1111/tbj.12726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mégane Meresse
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Anne-Déborah Bouhnik
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
| | - Marc-Karim Bendiane
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Frédérique Retornaz
- Departemental Geriatric Center; Polyvalent Geriatric Center; Marseille France
- Unit of Care and Research in Internal Medicine; Hôpital Européeen; Marseille France
| | - Frédérique Rousseau
- Pilot Unit of Research and Coordination in Geriatric Oncology; Department of Medicine; Institut Paoli-Calmettes; Marseille France
| | - Dominique Rey
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- ORS PACA, Southeastern Health Regional Observatory; Marseille France
| | - Roch Giorgi
- Aix Marseille University, INSERM, IRD, SESSTIM “Economics and Social Sciences Applied to Health & Analysis of Medical Information”; Marseille France
- Biostatistics & Information and Communication Technology Unit; APHM Timone hospital; Marseille France
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Adjuvant Radiation Improves Survival in Older Women Following Breast-Conserving Surgery for Estrogen Receptor–Negative Breast Cancer. Clin Breast Cancer 2016; 16:500-506.e2. [DOI: 10.1016/j.clbc.2016.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/23/2016] [Accepted: 06/17/2016] [Indexed: 11/19/2022]
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Cardiac safety of adjuvant non-pegylated liposomal doxorubicin combined with cyclophosphamide and followed by paclitaxel in older breast cancer patients. Breast 2016; 31:186-191. [PMID: 27886643 DOI: 10.1016/j.breast.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the cardiac safety of adjuvant Non-Pegylated Liposomal Doxorubicin (NPL-DOX) combined to Cyclophosphamide (CTX) and followed by weekly Paclitaxel, in older patients (≥65 years) with diagnosis of high risk breast cancer. The main end point of this prospective study was the detection of early episodes of symptomatic congestive heart failure (CHF). METHODS The cardiac function was evaluated by left ventricular ejection fraction (LVEF) measurements with repeated echocardiograms, performed 2 weeks before the beginning of chemotherapy and every 6 months, until 30 months after the study entry; then yearly for at least 5 years. RESULTS Forty-seven patients were enrolled from two Italian Divisions of Medical Oncology. Final results revealed no early episodes of symptomatic CHF within the first 12 months from the enrolment. Only two cardiac events were observed: an episode of atrial flutter after the first cycle of NPL-DOX and CTX, with a quick return to normal rhythm, and a grade 3 (scored to NCI-CTCAE, version 3.0) CHF episode, 18 months later chemotherapy start. No other relevant toxicities were reported. CONCLUSIONS This adjuvant combination including NPL-DOX in elderly patients, resulted in a low rate of cardiac toxic effects. Comparative trials should be encouraged to confirm these findings.
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245
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Sun J, Chia S. Adjuvant chemotherapy and HER-2-directed therapy for early-stage breast cancer in the elderly. Br J Cancer 2016; 116:4-9. [PMID: 27875517 PMCID: PMC5220141 DOI: 10.1038/bjc.2016.360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/28/2016] [Accepted: 10/06/2016] [Indexed: 02/01/2023] Open
Abstract
There is a lack of sufficient evidence-based data defining the optimal adjuvant systemic therapies in older women. Recommendations are mainly based on retrospective studies, subgroup analyses within larger randomised trials and expert opinion. Treatment decisions should consider the functional fitness of the patient, co-morbidities, in addition to chronological age with the aim to balance risks and potential benefits from treatment(s). In this review, we discuss assessment tools to aid clinicians to select elderly patients who are ‘fit' for chemotherapy, and review the literature on the use of chemotherapy and of the anti-HER 2 antibody trastuzumab in this population. We will also review two commonly used prediction models to assess their accuracy in predicting survival outcomes in elderly patients. Ongoing clinical trials specifically focusing on older patients may help to clarify the absolute benefits and risks of adjuvant systemic therapy in this age group.
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Affiliation(s)
- J Sun
- Department of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
| | - S Chia
- Department of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada
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Di Lascio S, Pagani O. Is it time to address survivorship in advanced breast cancer? A review article. Breast 2016; 31:167-172. [PMID: 27871024 DOI: 10.1016/j.breast.2016.10.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/31/2016] [Accepted: 10/26/2016] [Indexed: 02/08/2023] Open
Abstract
The outcome of advanced breast cancer has significantly improved over recent decades. As a consequence, the complex needs of patients living with the disease and their care-givers should be addressed not only in terms of supportive and palliative care but also of "survivorship" requirements. The multidisciplinary approach to advanced breast cancer should encompass - early in the history of the disease - not only physical but also functional, social, psychological and spiritual domains. It is important to clearly define the disease context with patients and families ("chronic" preferred to "incurable"), addressing the concept of uncertainty, and tailoring the treatment strategy according to both disease status and individual priorities. Specific psychosocial needs of young and elderly women and male patients - i.e. social security, job flexibility, rehabilitation (including sexuality), home and child care - should be recognized and supported. This review will address the key questions associated with survivorship in this disease context, recognizing the dearth of specific data and the urgent need for targeted clinical research and tailored interventions.
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Affiliation(s)
- Simona Di Lascio
- Institute of Oncology of Southern Switzerland (IOSI)), Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland.
| | - Olivia Pagani
- Institute of Oncology of Southern Switzerland (IOSI)), Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland
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247
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Villani D, Cognetta C, Toniolo D, Scanzi F, Riva G. Engaging Elderly Breast Cancer Patients: The Potential of eHealth Interventions. Front Psychol 2016; 7:1825. [PMID: 27899909 PMCID: PMC5110527 DOI: 10.3389/fpsyg.2016.01825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Daniela Villani
- Department of Psychology, Università Cattolica del Sacro Cuore Milan, Italy
| | - Chiara Cognetta
- Department of Medical Oncology, "G.Salvini" ASST Rhodense Milan, Italy
| | - Davide Toniolo
- Department of Medical Oncology, "G.Salvini" ASST Rhodense Milan, Italy
| | - Francesco Scanzi
- U.O. Oncologia Medica, Ospedale S. Giuseppe-Multimedica Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro CuoreMilan, Italy; Applied Technology for Neuro-Psychology Lab, Istituto Auxologico ItalianoMilan, Italy
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248
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Jolly TA, Williams GR, Bushan S, Pergolotti M, Nyrop KA, Jones EL, Muss HB. Adjuvant treatment for older women with invasive breast cancer. ACTA ACUST UNITED AC 2016; 12:129-45; quiz 145-6. [PMID: 26767315 DOI: 10.2217/whe.15.92] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Older women experience a large share of breast cancer incidence and death. With the projected rise in the number of older cancer patients, adjuvant chemo-, radiation and endocrine therapy management will become a key component of breast cancer treatment in older women. Many factors influence adjuvant treatment decisions including patient preferences, life expectancy and tumor biology. Geriatric assessment predicts important outcomes, identifies key deficits, and can aid in the decision making process. This review utilizes clinical vignettes to illustrate core principles in adjuvant management of breast cancer in older women and suggests an approach incorporating life expectancy and geriatric assessment.
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Affiliation(s)
- Trevor A Jolly
- Hematology & Oncology Division, University of North Carolina, Chapel Hill, NC 27599, USA.,Division of Geriatric Medicine & Center for Aging & Health, University of North Carolina, Chapel Hill, NC 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Grant R Williams
- Hematology & Oncology Division, University of North Carolina, Chapel Hill, NC 27599, USA.,Division of Geriatric Medicine & Center for Aging & Health, University of North Carolina, Chapel Hill, NC 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Sita Bushan
- Department of Medicine/School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Mackenzi Pergolotti
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kirsten A Nyrop
- Hematology & Oncology Division, University of North Carolina, Chapel Hill, NC 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Ellen L Jones
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Hyman B Muss
- Hematology & Oncology Division, University of North Carolina, Chapel Hill, NC 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
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249
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Specific Aspects of Breast Cancer Therapy of Elderly Women. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1381695. [PMID: 27807536 PMCID: PMC5078631 DOI: 10.1155/2016/1381695] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/19/2016] [Accepted: 08/30/2016] [Indexed: 01/13/2023]
Abstract
Breast cancer is the leading cause of death among women, and its incidence increases with age. The average age at diagnosis is 61 years, and the majority of deaths occurs after the age of 65 years. Optimal approach to elderly women with breast cancer is still a major challenge. Elderly patients with cancer should have at least a brief geriatric assessment to detect potentially treatable problems not always adequately evaluated by the oncologists. Therapeutic nihilism should be avoided and effective treatment provided, unless there are compelling reasons against it. Sharing the care for the patient with geriatricians or primary care physicians trained in geriatrics should be considered for all vulnerable and frail elderly patients.
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250
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Lee HC, Chen WY, Huang WT, Cheng KC, Tian YF, Ho CH, Tsao CJ, Feng YH. Impact of Adjuvant Chemotherapy in Elderly Breast Patients
in Taiwan, A Hospital-Based Study. Asian Pac J Cancer Prev 2016; 17:4591-4597. [PMID: 27892670 PMCID: PMC5454603 DOI: 10.22034/apjcp.2016.17.10.4591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: Decisions as to whether to provide adjuvant treatment in older breast cancer patients remains challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty. To aid decision-making, we retrospectively analyzed 110 women with breast cancer treated with a curative intention from 2006 to 2012. Survival data with clinical and pathological parameters were evaluated to address the role of adjuvant chemotherapy in this study population. Method: A total of 110 elderly (>70 years) patients that received mastectomy at two hospitals in Taiwan were observed retrospectively for a medium of 51 months. After mastectomy, patients received conservative treatment or adjuvant chemotherapy, or hormone therapy following clinical guidelines or physician’s preference. Data were collected from the cancer registry system. Results: Median age at diagnosis was 75.7 years. Thirty-five percent of patients received adjuvant chemotherapy, these having a significantly younger age (mean=74.0±5.3 vs 77.5±5.3, p<0.001) and higher tumor staging (p=0.003) compared with their non-chemotherapy counterparts. Five-year overall survival was non-significantly higher in patients who received adjuvant chemotherapy (with chemotherapy 64.2% vs without chemotherapy 62.6%, p=0.635), while five-year recurrence free survival was non-significantly lower (with chemotherapy 64.1% vs without chemotherapy 90.5%, p=0.80). Conclusions: In this analysis, adjuvant chemotherapy tended to be given to patients with a younger age and higher tumor staging at our institute. It was not associated with any statistically significant improvement in survival and recurrence rate. Until age specific recommendations are available, physicians must use their clinical judgment and assess the tumor biology with the patient’s comorbidities to make the best choice. Clinical trials focusing on this critical issue are warranted.
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Affiliation(s)
- Hsiu-Chuan Lee
- Department of Internal Medicine, Chi-Mei Medical Center, Yong Kang, Tainan, Taiwan,
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