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Matos E, Cankar K, Režun N, Dejanović K, Ovčariček T. Abemaciclib for the Treatment of HR+HER2- Metastatic Breast Cancer: An Institutional Experience. Cancers (Basel) 2024; 16:1828. [PMID: 38791907 PMCID: PMC11119494 DOI: 10.3390/cancers16101828] [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: 04/15/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Abemaciclib combined with endocrine therapy is a standard first- or later-line of treatment for HR+/HER2- metastatic breast cancer (MBC). The aim of this retrospective cohort study was to describe the outcomes of patients treated in a real-world setting, with particular focus on elderly patients. (2) Patients and methods: Patients treated with abemaciclib between November 2019 and February 2022 were included in the study. Data were collected from electronic medical records. The primary objective was to determine real-world progression-free survival (rwPFS), and secondary objectives included median overall survival (mOS) and safety. (3) Results: Analysis included 134 patients, with a median follow-up of 42 months. Median age was 62 years, with 29.9% aged 70+ years. A total of 51.5% of patients received abemaciclib in first-line, predominantly with aromatase inhibitor (68.1%). Median rwPFS was 21 in first-line and 20 months in the second-line, with no significant difference between treatment lines (HR 0.96; p = 0.88). Patients treated in the third- or later-line had a significantly shorter rwPFS, at 7 months (HR 1.48, p = 0.003). mOS was not reached in the first-line setting. For second- and third- or later-lines, mOS was 29 and 19 months, respectively. There was no significant difference in mOS between first- or second-line (HR 1.37, p = 0.36). In the 70+ group, median rwPFS was 15 months and mOS was 25 months with no significant difference compared to younger patients (rwPFS HR 1.1; p = 0.65; OS HR 1.4; p = 0.21). Most common adverse events (AEs) were diarrhoea (68.7%), anaemia (64.9%), and increased serum creatinine (63.4%). Grade 3/4 AEs were reported in 21.6% of patients. Dose reductions occurred in 30.6% of patients and were more frequent in patients 70+ (40%) compared to younger patients (28%); the difference was not significant (p = 0.22). At study cut-off, 64.9% of patients discontinued abemaciclib, primarily due to disease progression (73.5%). (4) Conclusions: Our study provides valuable insights into the effectiveness and safety of abemaciclib for the treatment of MBC. We observed comparable outcomes in terms of rwPFS and OS between the first two lines, suggesting consistent effectiveness across treatment lines. In addition, our findings suggest that older age (70+) does not significantly impact the effectiveness and tolerability of abemaciclib, although the careful monitoring and management of AEs are warranted.
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Affiliation(s)
- Erika Matos
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia (T.O.)
- Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Kaja Cankar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia (T.O.)
| | - Neža Režun
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia (T.O.)
| | - Katja Dejanović
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia (T.O.)
| | - Tanja Ovčariček
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia (T.O.)
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2
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Houvenaeghel G, Cohen M, Gonçalves A, Berthelot A, Chauvet MP, Faure C, Classe JM, Jouve E, Sabiani L, Bannier M, Tassy L, Martino M, Tallet A, de Nonneville A. Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment. Front Oncol 2023; 13:1287253. [PMID: 38162480 PMCID: PMC10757327 DOI: 10.3389/fonc.2023.1287253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ~60% of deaths from BC occur in women aged 70 years and older. Only limited data are available on the prognostic impact of age according to treatment, especially in the triple-negative (TN) and Her2-positive because of the lower frequency of these subtypes in elderly patients. We report herein the results of a multicenter retrospective study analyzing the prognostic impact of age according to treatment delivered in TN and Her2-positive BC patients of 70 years or older, including comparison by age groups. Methods The medical records of 31,473 patients treated from January 1991 to December 2018 were retrieved from 13 French cancer centers for retrospective analysis. Our study population included all ≥70 patients with TN or Her2-positive BC treated by upfront surgery. Three age categories were determined: 70-74, 75-80, and > 80 years. Results Of 528 patients included, 243 patients were 70-74 years old (46%), 172 were 75-80 years (32.6%) and 113 were >80 years (21.4%). Half the population (51.9%, 274 patients) were TN, 30.1% (159) Her2-positive/hormone receptors (HR)-positive, and, 18% (95) Her2-positive/endocrine receptors (ER)-negative BC. Advanced tumor stage was associated with older age but no other prognostic factors (tumor subtype, tumor grade, LVI). Adjuvant chemotherapy delivery was inversely proportional to age. With 49 months median follow-up, all patient outcomes (overall survival (OS), disease-free survival (DFS), breast cancer-specific survival (BCSS), and recurrence-free survival (RFS)) significantly decreased as age increased. In multivariate analysis, age >80, pT2-3 sizes, axillary macrometastases, lymphovascular involvement, and HR-negativity tumor negatively affected DFS and OS. Comparison between age >80 and <=80 years old showed worse RFS in patients aged > 80 (HR=1.771, p=0.031). Conclusion TN and Her2-positive subtypes occur at similar frequency in elderly patients. Older age is associated with more advanced tumor stage presentation. Chemotherapy use decreases with older age without worse other pejorative prognostic factors. Age >80, but not ≤80, independently affected DFS and OS.
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Affiliation(s)
- Gilles Houvenaeghel
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Monique Cohen
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Axel Berthelot
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | | | | | - Jean Marc Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France
| | - Eva Jouve
- Surgical Oncology Department, Centre Claudius Regaud, Toulouse, France
| | - Laura Sabiani
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Marie Bannier
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Louis Tassy
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Marc Martino
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Agnès Tallet
- Department of Radiotherapy, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Alexandre de Nonneville
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
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3
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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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4
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Gordon AL, Witham MD, Henderson EJ, Harwood RH, Masud T. Research into ageing and frailty. Future Healthc J 2021; 8:e237-e242. [PMID: 34286191 DOI: 10.7861/fhj.2021-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Research into ageing covers opportunities and challenges posed by an older population, and research to understand the ageing processes across the lifespan. The evidence base for Comprehensive Geriatric Assessment (CGA) is well established and efforts should now shift to understanding how to implement its principles across different healthcare contexts. Research around syndromes common in older people has progressed with variable success; while effective therapies for falls and cognitive impairment have been identified, older people with advanced frailty have commonly been excluded from Parkinson's disease and continence research. Research to understand the mechanisms of ageing has potential to mitigate against or treat emerging sarcopenia and cognitive impairment, and thus modify frailty trajectories. Pharmacogenetics could individualise therapeutics to reduce polypharmacy. These issues can only be addressed with development of infrastructure, capacity and expertise in ageing research. Commonly used research methodologies must be adapted to take account of frailty, cognitive impairment and functional dependency.
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Affiliation(s)
- Adam L Gordon
- British Geriatrics Society, London, UK, University of Nottingham School of Medicine, Nottingham, UK, NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK and University of Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Miles D Witham
- British Geriatrics Society, London, UK, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Emily J Henderson
- British Geriatrics Society, London, UK, Bristol Medical School, Bristol, UK and Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Rowan H Harwood
- British Geriatrics Society, London, UK, University of Nottingham School of Health Sciences, Nottingham, UK and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tahir Masud
- British Geriatrics Society, London, UK, University of Nottingham School of Medicine, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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5
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de Boer AZ, van de Water W, Bastiaannet E, de Glas NA, Kiderlen M, Portielje JEA, Extermann M. Early stage breast cancer treatment and outcome of older patients treated in an oncogeriatric care and a standard care setting: an international comparison. Breast Cancer Res Treat 2020; 184:519-526. [PMID: 32813120 PMCID: PMC7599178 DOI: 10.1007/s10549-020-05860-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022]
Abstract
Introduction Since older patients with breast cancer are underrepresented in clinical trials, an oncogeriatric approach is advocated to guide treatment decisions. However, the effect on outcomes is unclear. The aim of this study was to compare treatments and outcomes between patients treated in an oncogeriatric and a standard care setting. Methods Patients aged ≥ 70 years with early stage breast cancer were included. The oncogeriatric cohort comprised unselected patients from the Moffitt Cancer Center, and the standard cohort patients from a Dutch population-based cohort. Cox models were used to characterize the influence of care setting on recurrence risk and overall mortality. Results Overall, 268 patients were included in the oncogeriatric and 1932 patients in the standard cohort. Patients in the oncogeriatric cohort were slightly younger, had more comorbidity, and received more adjuvant endocrine therapy and chemotherapy. Oncogeriatric care was associated with a lower risk of recurrence, which remained significant after adjustment for patient and tumour characteristics [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.44–0.99]. Oncogeriatric care was also associated with a lower overall mortality, which also remained significant after adjustment for patient and tumour characteristics (HR 0.69, 95% CI 0.55–0.87). Conclusions Patients treated in the oncogeriatric care setting had a lower risk of recurrence, which may be explained by more systemic treatment. Overall mortality was also lower, but other explanations besides care setting could not be ruled out as the cohorts had different patient profiles. Future studies need to clarify the impact of an oncogeriatric approach on outcomes. Electronic supplementary material The online version of this article (10.1007/s10549-020-05860-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Z de Boer
- Department of Surgery, Leiden University Medical Center, Location J10-71, Postzone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Willemien van de Water
- Department of Surgery, Leiden University Medical Center, Location J10-71, Postzone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Location J10-71, Postzone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mandy Kiderlen
- Department of Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Martine Extermann
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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6
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An international comparison of treatment and short-term overall survival for older patients with pancreatic cancer. J Geriatr Oncol 2019; 10:584-590. [DOI: 10.1016/j.jgo.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/29/2018] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
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7
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Overcash J. Comprehensive Geriatric Assessment: Interprofessional Team Recommendations for Older Adult Women With Breast Cancer. Clin J Oncol Nurs 2019; 22:304-315. [PMID: 29781467 DOI: 10.1188/18.cjon.304-315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Geriatric oncology incorporates comprehensive geriatric assessment (CGA) and traditional oncology care. OBJECTIVES The aims are to identify limitations reflected by mean scores on the CGA instruments and describe the CGA recommendations documented in the medical record. METHODS CGA was administered and consisted of the Timed Up and Go Test, the Activities of Daily Living Scale, the Instrumental Activities of Daily Living Scale, grip strength, falls, pain, the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Geriatric Depression Scale, the Mini-Cog, and the Mini Nutritional Assessment. CGA recommendations were obtained from the medical record. Descriptive statistics were used to analyze the data. FINDINGS Most recommendations were for general cancer treatment, followed by fall referral/education.
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8
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de Nonneville A, Sabatier R, Gonçalves A, Extra JM, Tarpin C, Launay S, Tassy L, Viens P, Rousseau F. Safety and efficacy of eribulin for “real-world” older patients with metastatic breast cancer. J Geriatr Oncol 2018; 9:281-283. [DOI: 10.1016/j.jgo.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/02/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
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9
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Nguyen A, King TA. New Insights on the Role of Surgery for the Breast Primary Tumor in Patients Presenting With Stage IV Disease. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Gondos A, Jansen L, Heil J, Schneeweiss A, Voogd AC, Frisell J, Fredriksson I, Johansson U, Tvedskov TF, Jensen MB, Balslev E, Hartmann-Johnsen OJ, Sant M, Baili P, Agresti R, van de Velde T, Broeks A, Nogaret JM, Bourgeois P, Moreau M, Mátrai Z, Sávolt Á, Nagy P, Kásler M, Schrotz-King P, Ulrich C, Brenner H. Time trends in axilla management among early breast cancer patients: Persisting major variation in clinical practice across European centers. Acta Oncol 2016; 55:712-9. [PMID: 26878397 DOI: 10.3109/0284186x.2015.1136751] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79-96% and 49-92% for pT1 and pT2 tumors, respectively. Axillary lymph node dissection (ALND) use for pT1 tumors decreased from between 75% and 27% in 2003 to 47% and 12% in 2010, and from between 90% and 55% to 79% and 19% for pT2 tumors, respectively. In 2014, important differences in axillary management existed for patients with micrometastases only, and for patients fulfilling the ACOSOG Z0011 criteria for omitting ALND. Conclusion This study demonstrates persisting differences in important aspects of axillary management throughout the recent decade. The results highlight the need for international comparative patterns of care studies in oncology, which may help to identify areas where further studies and consensus building may be necessary.
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Affiliation(s)
- Adam Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jörg Heil
- Breast Unit, Women Hospital, National Center of Tumor Diseases, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Andreas Schneeweiss
- Division of Gynecologic Oncology, National Center for Tumor Diseases, University Hospital, Heidelberg, Germany
| | - Adri C. Voogd
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Section of Breast Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery, Section of Breast Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ulla Johansson
- Department of Molecular Medicine and Surgery, Section of Breast Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Eva Balslev
- Department of Pathology, Herlev Hospital, Herlev, Denmark
| | | | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Roberto Agresti
- Breast Cancer Surgical Oncology Unit, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Tony van de Velde
- Tumor Registry, Department of Biometrics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jean-Marie Nogaret
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Brussels, Belgium
| | - Pierre Bourgeois
- Service of Nuclear Medicine, Institute Jules Bordet, Brussels, Belgium
| | - Michel Moreau
- Data Center, Institute Jules Bordet, Brussels, Belgium
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Ákos Sávolt
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Péter Nagy
- Department of Molecular Immunology and Toxicology, National Institute of Oncology, Budapest, Hungary
- Department of International Relations, National Institute of Oncology, Budapest, Hungary
| | - Miklós Kásler
- Center of Surgical Oncology, National Institute of Oncology, Budapest, Hungary
| | - Petra Schrotz-King
- Division of Preventive Oncology, National Center for Tumor Diseases, and German Cancer Research Center, Heidelberg, Germany
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Cornelia Ulrich
- Division of Preventive Oncology, National Center for Tumor Diseases, and German Cancer Research Center, Heidelberg, Germany
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, National Center for Tumor Diseases, and German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
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11
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Swaminathan D, Swaminathan V. Geriatric oncology: problems with under-treatment within this population. Cancer Biol Med 2015; 12:275-83. [PMID: 26779364 PMCID: PMC4706517 DOI: 10.7497/j.issn.2095-3941.2015.0081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/24/2015] [Indexed: 12/12/2022] Open
Abstract
We are currently faced with an aging population, which is rapidly growing worldwide. Two thirds of cancer occurs in the over 65-year age group. Societal conceptions from the past have created ageist stereotypes; old age is associated with frailty and the elderly are perceived to be destined for deterioration and loss of independence. Cancer within the elderly is also subject to these stereotypes, with elderly cancer patients considered by some not as likely to recover as younger patients with cancer. We summarise and review the current concerns regarding elderly management and treatments utilised for the management of oncological disease in the elderly, and discuss the impact of under-treatment within this population.
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Affiliation(s)
- Divya Swaminathan
- 1 Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK ; 2 Health Education North West, Liverpool L3 4BL, UK
| | - Vikram Swaminathan
- 1 Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK ; 2 Health Education North West, Liverpool L3 4BL, UK
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On and off Metronomic Oral Vinorelbine in Elderly Women with Advanced Breast Cancer. TUMORI JOURNAL 2015; 101:30-5. [DOI: 10.5301/tj.5000207] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 11/20/2022]
Abstract
Background Elderly patients with metastatic breast cancer (MBC) have more problems receiving chemotherapy than younger patients, especially with the presence of multiple comorbidities, adverse drug events and functional decline. Low-dose oral administration of cytotoxic agents such as vinorelbine, a semisynthetic vinca alkaloid that interferes with microtubule assembly, leading to arrest of cell division, is usually effective and well tolerated. Methods From February 2010 to February 2014, 32 patients with MBC, median age 76 years (range 69-83) were treated with oral vinorelbine 30 mg (total dose), one day on and one day off, until disease progression or unacceptable toxicity levels were reported. Toxicity, quality of life and clinical benefit were evaluated. Matched t-tests were conducted to discern whether quality-of-life indicator (p<0.05 was considered significant) differed before and 6 months after treatment. Statistical analysis was performed using Graph Pad Prism 5.0 (GraphPad Software Inc., San Diego, CA, USA). Results No grade 3 and 4 adverse events were reported. A clinical benefit of 50% was found in our cohort. On and off metronomic vinorelbine oral administration resulted in good tolerability and safe profile in our selected elderly population, and improved patient adherence to therapy. Conclusions The present study demonstrated that metronomic vinorelbine might be a potential treatment in elderly patients by reducing adverse effects and increasing quality of life, setting the stage for future extensive clinical trials.
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Third Symposium on Primary Breast Cancer in Older Women. Future Oncol 2015; 11:1-23. [DOI: 10.2217/fon.15.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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de Glas NA, Bastiaannet E, de Craen AJM, van de Velde CJH, Siesling S, Liefers GJ, Portielje JEA. Survival of older patients with metastasised breast cancer lags behind despite evolving treatment strategies--a population-based study. Eur J Cancer 2015; 51:310-6. [PMID: 25559617 DOI: 10.1016/j.ejca.2014.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older women are more likely to be diagnosed with primary metastasised breast cancer than their younger counterparts. Evolving treatment strategies of metastasised breast cancer have resulted in improved survival in younger patients, but it remains unclear if this improvement has occurred in older patients as well. The aim of this study was to assess changes in treatment strategies over time in relation to overall and relative survival of older patients compared to younger patients with primary metastasised breast cancer. METHODS All patients with a breast cancer diagnosis and distant metastases at first presentation (stage IV), between 1990 and 2012, were selected from the Netherlands Cancer Registry. Changes in treatment over time per age-group (<65 years, 65-75 years and >75 years) were assessed using logistic regression. Overall survival over time was calculated using Cox Regression Models and relative survival was assessed using the Ederer II method. RESULTS Overall, 14,310 patients were included. Treatment strategies have strongly changed in the past twenty years; especially the use of chemotherapy has increased (P<0.001 in all age-groups). Overall survival of patients <65 has significantly improved (Hazard Ratio (HR) per year 0.98, 95% Confidence Interval (CI) 0.98-0.99, P<0.001), but the survival of older patients has not improved (HR 1.00, 95% CI 0.99-1.01, P=0.86 for patients aged 65-75 and HR 1.00, 95% CI 1.00-1.01, P=0.46 for patients aged >75). Similarly, relative survival has improved in patients <65 but not in women aged 65-75 and >75. CONCLUSION Overall and relative survival of older patients with metastasised breast cancer at first presentation have not improved in recent years in contrast with the survival of younger patients, despite increased treatment with chemotherapy for women of all ages. Future studies should focus on stratification models that can be used to predict which patients may benefit from specific treatment options.
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Affiliation(s)
- N A de Glas
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - E Bastiaannet
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - A J M de Craen
- Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - C J H van de Velde
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - S Siesling
- Comprehensive Cancer Centre the Netherlands, Department of Research, P.O. Box 19079, 3501 DB Utrecht, The Netherlands
| | - G J Liefers
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - J E A Portielje
- Haga Hospital The Hague, Department of Internal Medicine, Leyweg 275, 2545 CH Den Haag, The Netherlands.
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