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Jackson EB, Curry L, Mariano C, Hsu T, Cook S, Pezo RC, Savard MF, Desautels DN, Leblanc D, Gelmon KA. Key Considerations for the Treatment of Advanced Breast Cancer in Older Adults: An Expert Consensus of the Canadian Treatment Landscape. Curr Oncol 2023; 31:145-167. [PMID: 38248095 PMCID: PMC10814011 DOI: 10.3390/curroncol31010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
The prevalence of breast cancer amongst older adults in Canada is increasing. This patient population faces unique challenges in the management of breast cancer, as older adults often have distinct biological, psychosocial, and treatment-related considerations. This paper presents an expert consensus of the Canadian treatment landscape, focusing on key considerations for optimizing selection of systemic therapy for advanced breast cancer in older adults. This paper aims to provide evidence-based recommendations and practical guidance for healthcare professionals involved in the care of older adults with breast cancer. By recognizing and addressing the specific needs of older adults, healthcare providers can optimize treatment outcomes and improve the overall quality of care for this population.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Lauren Curry
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Caroline Mariano
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Sarah Cook
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
- Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Rossanna C. Pezo
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada;
- Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Marie-France Savard
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Danielle N. Desautels
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Dominique Leblanc
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada
| | - Karen A. Gelmon
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Tian C, Yang J, Xie N, Tang Y, Zhou H, Hu ZY, Ouyang Q. The prognosis and risk factors for capecitabine maintenance treatment in metastatic breast cancer: a retrospective comparative cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:924. [PMID: 36172110 PMCID: PMC9511179 DOI: 10.21037/atm-22-3828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
Background Maintenance treatment following efficient chemotherapy can improve the treatment outcomes of patients with metastatic breast cancer (MBC). However, there are no studies for identifying the prognostic factors for patients who could benefit from capecitabine maintenance. Therefore, this study aimed to investigate the prognosis and risk factors of capecitabine maintenance therapy and analysed the circulating tumour DNA (ctDNA) markers that may be related to the treatment response. Methods This study recruited 482 consecutive patients with MBC who achieved clinical benefit from capecitabine-based chemotherapy from 2011 to 2019. A total of 256 patients received subsequent capecitabine maintenance therapy. The baseline clinical factors included age at diagnosis, menopause, neoadjuvant therapy, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and subtypes, prior treatment lines, and prior capecitabine-based treatment response. Treatment outcome (progression-free survival, PFS) was assessed by imaging tools according to RSCIST 1.1 standard during the first two treatment cycles and every 3 weeks thereafter. Univariate and multivariate Cox proportional hazards models were used to analysethe association between capecitabine maintenance treatment and prognosis. Results The median PFS of patients receiving capecitabine maintenance treatment was 21.7 months [95% confidence interval (CI): 15.1-36.3 months]. Capecitabine maintenance showed similar effects as endocrine maintenance or anti-HER2 therapy in hormone receptor (HR)-positive or HER2-positive patients, with adjusted HR of 1.17 (95% CI: 0.81-1.71, P=0.40). In patients with triple-negative breast cancer (TNBC), capecitabine maintenance showed a marginal benefit in PFS. Compared to late-line (≥2) capecitabine maintenance, first-line capecitabine maintenance significantly prolonged median PFS. Compared to other HR/HER2 subtypes, patients with HR-positive and HER2-positive subtypes significantly benefited from capecitabine maintenance treatment. Analysis of ctDNA revealed that among patients receiving capecitabine maintenance, TP53 aberrations were concentrated in patients with short PFS. Conclusions Capecitabine maintenance treatment is associated with longer PFS in patients with MBC, especially those receiving first-line capecitabine-based chemotherapy and those with HR positivity/HER2 positivity. TP53 aberrations may be responsible for the poor response to capecitabine maintenance treatment.
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Affiliation(s)
- Can Tian
- Medical Department of Breast Cancer, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.,Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Jianbo Yang
- The Immunotherapy Research Laboratory, Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA.,The Cancer Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ning Xie
- Medical Department of Breast Cancer, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.,Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Yu Tang
- Medical Department of Breast Cancer, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.,Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Haoyu Zhou
- College of Information and Intelligence, Hunan Agricultural University, Changsha, China
| | - Zhe-Yu Hu
- Medical Department of Breast Cancer, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.,Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Quchang Ouyang
- Medical Department of Breast Cancer, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China.,Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
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