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Bandini A, Calabrò PF, Banchi M, Orlandi P, Bocci G. Metronomic Chemotherapy in Elderly Patients. Curr Oncol Rep 2024; 26:359-376. [PMID: 38448722 PMCID: PMC11021319 DOI: 10.1007/s11912-024-01505-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE OF REVIEW This review describes the most relevant studies found in the scientific literature regarding metronomic chemotherapy (MCT) in the geriatric oncology population to support its use as a feasible treatment of care in the frail elderly patients. RECENT FINDINGS Recent years have seen a reevaluation of cancer chemotherapeutic drugs and MCT is an emerging schedule in phase II and III clinical trials. Ageing is one of the risk factors for the development of cancer, the incidence of whom increases dramatically in people who live longer. To date, standard oncological protocols involve chemotherapeutic drugs in short cycles of therapy at the maximum tolerated dose (MTD). Although these therapeutic regimens may be successful, they can cause important adverse drug reactions, especially in elderly or frail patients. MCT is a different modality of delivery of chemotherapeutic drugs (frequent low dose for prolonged time) and it looks at the overcoming of the limitations and disadvantages of MTD, in particular the toxicity aspect. We reviewed the experience of clinicians who have used MCT in clinical trials enrolling elderly patients with different cancer types.
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Affiliation(s)
- Arianna Bandini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Pasquale Fabio Calabrò
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Marta Banchi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Paola Orlandi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126, Pisa, Italy
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126, Pisa, Italy.
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Cui R, Wang XL, Cao J. Implantation of computed tomography-guided high-dose-rate 192Ir brachytherapy in oldest old patients with advanced non-small cell lung cancer: A case report and literature review. Medicine (Baltimore) 2022; 101:e32450. [PMID: 36595988 PMCID: PMC9803449 DOI: 10.1097/md.0000000000032450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND With the increasing aging and the popularization of medical diagnosis, the growing number of oldest old with lung cancer needs to be focused on. Several medical and physiological challenges often accompanying the oldest old cancer patients make the choice of the optimal treatment daunting. The current research suggests that people who get adequate treatment can benefit, but it is worth discussing which treatment will benefit them more. High-dose-rate (HDR) 192Ir brachytherapy deserves attention in this context owing to its association with less trauma and reduced complications. CASE PRESENTATION An 86-years-old woman with a right glandular lung carcinoma presented with progressive lesions 11 months after chemotherapy. Because of her old age and poor performance status (eastern cooperative oncology group performance status 3), she received HDR 192Ir brachytherapy for her right lung lesion without any common complications, such as pneumothorax and hemorrhage. She continued on 0.25 g oral gefitinib each day after received brachytherapy treatment. The right lung lesion keeps a partial response until 18 months later now. CONCLUSION HDR 192Ir brachytherapy can potentially be used as a safe and effective choice for the oldest old with advanced non-small cell lung cancer. It can especially benefit cancer patients with concurrent chemotherapy or targeted therapy.
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Affiliation(s)
- Ran Cui
- Department of Oncology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, China
| | - Xiu-Lan Wang
- Department of Oncology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, China
| | - Jian Cao
- Department of Oncology, The First People’s Hospital of Neijiang, Neijiang, Sichuan, China
- * Correspondence: Jian Cao, Department of Oncology, The First People’s Hospital of Neijiang, Neijiang 641000, Sichuan, China (e-mail: )
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Bensken WP, Schiltz NK, Warner DF, Kim DH, Wei MY, Quiñones AR, Ho VP, Kelley AS, Owusu C, Kent EE, Koroukian SM. Comparing the association between multiple chronic conditions, multimorbidity, frailty, and survival among older patients with cancer. J Geriatr Oncol 2022; 13:1244-1252. [PMID: 35786369 PMCID: PMC9798334 DOI: 10.1016/j.jgo.2022.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The high prevalence of multiple chronic conditions (MCC), multimorbidity, and frailty may affect treatment and outcomes for older adults with cancer. The goal of this study was to use three conceptually distinct measures of morbidity to examine the association between these measures and mortality. MATERIALS AND METHODS Using Medicare claims data linked with the 2012-2016 Ohio Cancer Incidence Surveillance System we identified older adults with incident primary cancer sites of breast, colorectal, lung, or prostate (n = 29,140). We used claims data to identify their Elixhauser comorbidities, Multimorbidity-Weighted Index (MWI), and Claims Frailty Index (CFI) as measures of MCC, multimorbidity, and frailty, respectively. We used Cox proportional hazard models to examine the association between these measures and survival time since diagnosis. RESULTS Lung cancer patients had the highest levels of MCC, multimorbidity, and frailty. There was a positive association between all three measures and a greater hazard of death after adjusting for age, sex (colorectal and lung only), and stage. Breast cancer patients with 5+ comorbidities had an adjusted hazard ratio (aHR) of 1.63 (95% confidence interval [CI]: 1.38, 1.93), and those with mild frailty had an aHR of 3.38 (95% CI; 2.12, 5.41). The C statistics for breast cancer were 0.79, 0.78, and 0.79 for the MCC, MWI, and CFI respectively. Similarly, lung cancer patients who were moderately or severely frail had an aHR of 1.82 (95% CI: 1.53, 2.18) while prostate cancer patients had an aHR of 3.39 (95% CI: 2.12, 5.41) and colorectal cancer patients had an aHR of 4.51 (95% CI: 3.23, 6.29). Model performance was nearly identical across the MCC, multimorbidity, and frailty models within cancer type. The models performed best for prostate and breast cancer, and notably worse for lung cancer. The frailty models showed the greatest separation in unadjusted survival curves. DISCUSSION The MCC, multimorbidity, and frailty indices performed similarly well in predicting mortality among a large cohort of older cancer patients. However, there were notable differences by cancer type. This work highlights that although model performance is similar, frailty may serve as a clearer indicator in risk stratification of geriatric oncology patients than simple MCCs or multimorbidity.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Nicholas K Schiltz
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America
| | - David F Warner
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Center for Family & Demographic Research, Bowling Green State University, Bowling Green, OH, United States of America
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Melissa Y Wei
- Division of General Internal Medicine and Health Services Research, Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States of America; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States of America
| | - Vanessa P Ho
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Department of Surgery, MetroHealth Medical Center, Cleveland, OH, United States of America
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America; Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, OH, United States of America
| | - Erin E Kent
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America
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Hamilton JAG, Lee MY, Hunter R, Ank RS, Story JY, Talekar G, Sisroe T, Ballak DB, Fedanov A, Porter CC, Eisenmesser EZ, Dinarello CA, Raikar SS, DeGregori J, Henry CJ. Interleukin-37 improves T-cell-mediated immunity and chimeric antigen receptor T-cell therapy in aged backgrounds. Aging Cell 2021; 20:e13309. [PMID: 33480151 PMCID: PMC7884049 DOI: 10.1111/acel.13309] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/17/2020] [Accepted: 12/31/2020] [Indexed: 12/20/2022] Open
Abstract
Aging‐associated declines in innate and adaptive immune responses are well documented and pose a risk for the growing aging population, which is predicted to comprise greater than 40 percent of the world's population by 2050. Efforts have been made to improve immunity in aged populations; however, safe and effective protocols to accomplish this goal have not been universally established. Aging‐associated chronic inflammation is postulated to compromise immunity in aged mice and humans. Interleukin‐37 (IL‐37) is a potent anti‐inflammatory cytokine, and we present data demonstrating that IL‐37 gene expression levels in human monocytes significantly decline with age. Furthermore, we demonstrate that transgenic expression of interleukin‐37 (IL‐37) in aged mice reduces or prevents aging‐associated chronic inflammation, splenomegaly, and accumulation of myeloid cells (macrophages and dendritic cells) in the bone marrow and spleen. Additionally, we show that IL‐37 expression decreases the surface expression of programmed cell death protein 1 (PD‐1) and augments cytokine production from aged T‐cells. Improved T‐cell function coincided with a youthful restoration of Pdcd1, Lat, and Stat4 gene expression levels in CD4+ T‐cells and Lat in CD8+ T‐cells when aged mice were treated with recombinant IL‐37 (rIL‐37) but not control immunoglobin (Control Ig). Importantly, IL‐37‐mediated rejuvenation of aged endogenous T‐cells was also observed in aged chimeric antigen receptor (CAR) T‐cells, where improved function significantly extended the survival of mice transplanted with leukemia cells. Collectively, these data demonstrate the potency of IL‐37 in boosting the function of aged T‐cells and highlight its therapeutic potential to overcome aging‐associated immunosenescence.
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Affiliation(s)
- Jamie A. G. Hamilton
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | - Miyoung Y. Lee
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | - Rae Hunter
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | - Raira S. Ank
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | - Jamie Y. Story
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
- Molecular and Systems Pharmacology Graduate Program Graduate Division of Biological and Biomedical Sciences Laney Graduate School Emory University School of Medicine Atlanta GA USA
| | - Ganesh Talekar
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | | | - Dov B. Ballak
- Department of Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora CO USA
- Department of Medicine Radboud University Medical Center Nijmegen The Netherlands
| | - Andrew Fedanov
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | - Christopher C. Porter
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | - Elan Z. Eisenmesser
- Department of Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Charles A. Dinarello
- Department of Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora CO USA
- Department of Medicine Radboud University Medical Center Nijmegen The Netherlands
| | - Sunil S. Raikar
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
| | - James DeGregori
- Department of Biochemistry and Molecular Genetics University of Colorado Anschutz Medical Campus Aurora CO USA
- Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO USA
- Department of Immunology and Microbiology University of Colorado Anschutz Medical Campus Aurora CO USA
- Department of Pediatrics University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Curtis J. Henry
- Department of Pediatrics Emory University School of Medicine Atlanta GA USA
- Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta Atlanta GA USA
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Estevinho F, Gomes R, Hasmucrai D, Barata F. Metronomic oral vinorelbine in a real-world population of advanced non-small cell lung cancer patients. Pulmonology 2020; 28:368-375. [DOI: 10.1016/j.pulmoe.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/26/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
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Yamada T, Uchino J, Chihara Y, Shimamoto T, Iwasaku M, Tamiya N, Kaneko Y, Kiyomi F, Takayama K. Rationale and design of a phase II trial of durvalumab treatment in patients with NSCLC ineligible for stage III chemoradiotherapy following radiation monotherapy (SPIRAL-RT study). Ther Adv Med Oncol 2020; 12:1758835920927841. [PMID: 32536981 PMCID: PMC7268142 DOI: 10.1177/1758835920927841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 04/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background: In the PACIFIC study, progression-free survival (PFS) and overall survival (OS) of patients with unresectable, locally advanced, stage III non-small cell lung cancer (NSCLC) were prolonged by durvalumab as maintenance therapy after radical concurrent chemoradiotherapy using platinum-based antitumor agents. However, no data were obtained to reveal the efficacy of durvalumab after radiation monotherapy in patients unsuitable for chemoradiotherapy. Here, we describe an ongoing single-arm, prospective, open-label, multicenter phase II trial of durvalumab in patients with NSCLC ineligible for stage III chemoradiotherapy following radiation monotherapy (SPIRAL-RT study). Methods: Durvalumab at 10 mg/kg body weight is administered every 2 weeks after radiation therapy until individual patients meet the discontinuation criteria. The treatment duration is up to 12 months. The primary endpoint is the 1-year PFS rate. Secondary endpoints are response rate, PFS, OS, and safety. Durvalumab treatment after radiation monotherapy is expected to prolong 1-year PFS rate and have acceptable adverse events. Discussion: We are conducting an intervention study to investigate the safety and efficacy of durvalumab treatment in patients with NSCLC ineligible for stage III chemoradiotherapy following radiation monotherapy.
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Affiliation(s)
- Tadaaki Yamada
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto 602-0857, Japan
| | - Yusuke Chihara
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takayuki Shimamoto
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuyo Tamiya
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiko Kaneko
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiaki Kiyomi
- Statistics and Data Center, Clinical Research Support Center Kyushu, Fukuoka, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Drevet G, Maury JM, Ginoux M, Tronc F. [Short-term results of video-assisted lung cancer surgery in octogenarians]. Rev Mal Respir 2020; 37:293-298. [PMID: 32273117 DOI: 10.1016/j.rmr.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/31/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Due to an increase in life expectancy, onco-pulmonologists and thoracic surgeons are more frequently faced with octogenarian patients with lung cancer. In this age group, treatment modalities may need to be revised because of the increasing presence of comorbidities. Surgery remains the reference treatment for early stage disease, but mortality rates and postoperative complications are higher in this group of patients. One of the solutions to reduce the operative risk would be to develop videoassisted thoracoscopic pulmonary resection surgery. The aim of this study was to evaluate the results of this form of lung cancer surgery in octogenarians. METHODS All patients 80 years old or more who underwent videoassisted lung cancer surgery from 2014 to 2018 at Lyon University Hospital were included. Wedge resections and diagnostic procedures were excluded. RESULTS Nineteen patients (13 men, 6 women) were included. The median age was 82 years old. All patients had undergone videoassisted lobectomy. Three patients required conversion to thoracotomy (15.8%). All patients underwent complete resection (R0). One patient had N1 lymph node involvement, all others were N0. The postoperative complication rate was 68.4%, the majority of which were grade II of the Clavien classification. Perioperative mortality was 5.3%. CONCLUSIONS Videoassisted lung cancer resection in a selected population of octogenarians is associated with satisfactory short-term results. It is reasonable to favour minimally invasive techniques in this population, even if the proof of their superiority has not yet been firmly established.
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Affiliation(s)
- G Drevet
- Service de chirurgie thoracique, de transplantation pulmonaire et cardiopulmonaire, hôpital Louis-Pradel, Lyon, France.
| | - J-M Maury
- Service de chirurgie thoracique, de transplantation pulmonaire et cardiopulmonaire, hôpital Louis-Pradel, Lyon, France
| | - M Ginoux
- Service de pneumologie, hôpital Louis-Pradel, Lyon, France
| | - F Tronc
- Service de chirurgie thoracique, de transplantation pulmonaire et cardiopulmonaire, hôpital Louis-Pradel, Lyon, France
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Ebi H, Boikos S, Faber AC. Respecting your elders: osimertinib demonstrates preferential activity in elderly patients with T790M positive non-small cell lung cancers. J Thorac Dis 2019; 11:S1844-S1846. [PMID: 31632765 DOI: 10.21037/jtd.2019.08.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hiromichi Ebi
- Division of Molecular Therapeutics, Aichi Cancer Center Research Institute, Nagoya, Japan.,Precision Medicine Center, Aichi Cancer Center, Nagoya, Japan.,Division of Advanced Cancer Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Anthony C Faber
- Philips Institute for Oral Health Research, VCU School of Dentistry and Massey Cancer Center, Richmond, VA, USA
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Singhal U, George AK, Tosoian JJ. EDITORIAL COMMENT. Urology 2019; 130:111-112. [PMID: 31345285 DOI: 10.1016/j.urology.2019.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Udit Singhal
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI; University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Hoang JM, Upadhyay N, Dike DN, Lee J, Johnson ML, Cleeland CS, Mendoza T, Chen H, Trivedi MV. Patient-reported outcomes in light of supportive medications in treatment-naïve lung cancer patients. Support Care Cancer 2019; 28:1809-1816. [PMID: 31338641 DOI: 10.1007/s00520-019-05004-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The impact of supportive medications on patient-reported outcomes (PROs) has not been systematically evaluated. We describe the supportive medications used by treatment-naïve lung cancer patients and assess their association with PROs from MD Anderson Symptom Inventory (MDASI). METHODS Treatment-naïve lung cancer patients who completed PROs from MDASI at the initial visit to MD Anderson Cancer Center were included. Medications from the initial visit were abstracted from the electronic medical records system and categorized into therapeutic classes based on U.S. Pharmacopeia v7.0. A chi-square or Mann-Whitney U test was conducted as appropriate. RESULTS Among 459 patients, ~ 50% took any analgesics and 25% were on opioids. One-third of patients with moderate-severe pain were not on any analgesics. Patients taking opioids had significantly worse median pain scores (6 vs. 0) compared with those not taking any analgesics (p < 0.0001). Higher proportion of patients with moderate-severe pain took opioids compared with those with mild pain (52% vs. 16%, p < 0.0001). Patients on opioids also reported significantly worse scores for five other cancer-specific core symptoms and all six symptoms rating interference with daily life. Only 15% of patients with higher composite score for depression-related symptoms were on antidepressants. However, patients taking antidepressants did not significantly differ in any individual MDASI symptom scores compared with those not on antidepressants (p = 0.4858). CONCLUSIONS Our results suggest a need for better screening for pain and depression and optimization of pain management in treatment-naïve lung cancer patients since their poor functional status may result in suboptimal cancer therapy.
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Affiliation(s)
- Johnny M Hoang
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Navneet Upadhyay
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Dozie N Dike
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Jaekyu Lee
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Michael L Johnson
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA
| | - Meghana V Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Health Building-2, 4849 Calhoun Rd., Houston, TX, 77204, USA.
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Fanotto V, Fornaro L, Bordonaro R, Rosati G, Rimassa L, Di Donato S, Santini D, Tomasello G, Leone F, Silvestris N, Stragliotto S, Scartozzi M, Giampieri R, Nichetti F, Antonuzzo L, Cinieri S, Avallone A, Pellegrino A, Melisi D, Vasile E, Gerratana L, Aprile G. Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study. J Geriatr Oncol 2018; 10:591-597. [PMID: 30551958 DOI: 10.1016/j.jgo.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/04/2018] [Accepted: 11/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Although gastric cancer (GC) incidence rises with age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines. MATERIALS AND METHODS Clinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test. RESULTS Older patients represented 31.8% of the population (N = 868). Intestinal type was more frequent in older patients (P = .02). Poorly differentiated tumours were more often observed in non-older patients (P = .009). At stage IV diagnosis, the rate of liver metastases was higher in older patients (P = .02), while peritoneal spread was more represented in non-older patients (P = .002). Although older patients were more often treated with monotherapy (P = .001), they had similar PFS (HR 0.86, 95%CI 0.71-1.03, P = .102) and OS (HR 0.82, 95%CI 0.65-1.02, P = .08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups. CONCLUSION In our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano(MI), Italy
| | | | | | | | - Francesco Leone
- Medical Oncology, University of Turin, Candiolo Cancer Institute, FPO, IRCCS, Turin, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | - Silvia Stragliotto
- UOC Oncologia Medica 1, Dip. di Oncologia, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Mario Scartozzi
- Medical Oncology, University of Cagliari, University Hospital, Cagliari, Italy
| | | | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Antonio Avallone
- Experimental Abdomen Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | | | | | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy; Department of Oncology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy.
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12
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Camerini A, Banna GL, Cinieri S, Pezzuto A, Mencoboni M, Rosetti F, Figueiredo A, Rizzo P, Ricci A, Langenhoven L, Santo A, Addeo A, Amoroso D, Barata F. Metronomic oral vinorelbine for the treatment of advanced non-small cell lung cancer: a multicenter international retrospective analysis. Clin Transl Oncol 2018; 21:790-795. [PMID: 30448956 DOI: 10.1007/s12094-018-1989-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Metronomic oral vinorelbine (MOV) could be a treatment option for unfit patients with advanced non-small cell lung cancer (NSCLC) based on its safety profile and high patient compliance. METHODS We retrospectively collected data on 270 patients [median age 76 (range 48-92) years, M/F 204/66, PS 0 (27)/1 (110)/≥ 2 (133), median of 3 serious comorbidities] with stage IIIB-IV NSCLC treated with MOV as first (T1) (67%), second (T2) (19%) or subsequent (T3) (14%) line. Schedules consisted of vinorelbine 50 mg (138), 40 mg (68) or 30 mg (64) three times a week continuously. RESULTS Patients received an overall median of 6 (range 1-25) cycles with a total of 1253 cycles delivered. The overall response rate was 17.8% with 46 partial and 2 complete responses and 119 patients (44.1%) experienced stable disease > 12 weeks with an overall disease control rate of 61.9%. Median overall time to progression was 5 (range 1-21) months [T1 7 (1-21), T2 5.5 (1-19) and T3 4 (1-19) months] and median overall survival 9 (range 1-36) months [T1 10 (1-31), T2 8 (1-36) and T3 6.5 (2-29) months]. Treatment was extremely well tolerated with 2% (25/1253) G3/4 toxicity (mainly G3 fatigue and anemia) and no toxic deaths. We observed the longer OS 14 (range 7-36) months in a subset of squamous NSCLC patients receiving immunotherapy after metronomic oral vinorelbine. CONCLUSION We confirmed MOV as an extremely safe treatment in a large real world population of advanced NSCLC with an interesting activity mainly consisting of long-term disease stabilization. We speculate the possibility of a synergistic effect with subsequent immunotherapy.
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Affiliation(s)
- A Camerini
- Medical Oncology, Versilia Hospital - ASL Toscana Nord-Ovest, via Aurelia 335, 55043, Lido di Camaiore, LU, Italy.
| | - G L Banna
- Division of Medical Oncology, Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - S Cinieri
- Medical Oncology, Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - A Pezzuto
- Department of Cardio-Thoracic-Vascular Science, S. Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - M Mencoboni
- Medical Oncology, ASL 3 Genovese, Ospedale Villa Scassi, Corso Onofrio Scassi 1, 16121, Genoa, Italy
| | - F Rosetti
- Medical Oncology, ULSS3 Serenissima, Distretto Mirano-Dolo, Via Pasteur, 30031, Dolo, VE, Italy
| | - A Figueiredo
- Pneumology, Centro Hospitalar e Universitario de Coimbra, Avenida Doutor Bissaya Barreto S/N, Praceta De Mota Pinto, Celas-Coimbra, Portugal
| | - P Rizzo
- Medical Oncology, Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - A Ricci
- Department of Molecular and Clinical Medicine, S. Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - L Langenhoven
- Clinical Oncology, Panorama Oncology Centre, 43 Hennie Winterbach St, Panorama, Cape Town, 7500, South Africa
| | - A Santo
- Medical Oncology, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - A Addeo
- Oncology Department, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - D Amoroso
- Medical Oncology, Versilia Hospital - ASL Toscana Nord-Ovest, via Aurelia 335, 55043, Lido di Camaiore, LU, Italy
| | - F Barata
- Pneumology, Centro Hospitalar e Universitario de Coimbra, Avenida Doutor Bissaya Barreto S/N, Praceta De Mota Pinto, Celas-Coimbra, Portugal
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13
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Goede V, Stauder R. Multidisciplinary care in the hematology clinic: Implementation of geriatric oncology. J Geriatr Oncol 2018; 10:497-503. [PMID: 30241779 DOI: 10.1016/j.jgo.2018.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/04/2018] [Accepted: 09/05/2018] [Indexed: 11/19/2022]
Abstract
Multidisciplinary care is believed to provide benefits to patients with cancer. Tumor board conferences as well aspalliative care or psycho-oncological services have not only become common in oncology, but also in hematology clinics dedicated to the treatment of hematological cancers. Malignant hematological diseases are highly prevalent among older persons. Demographic changes in many countries worldwide are prompting the integration of geriatric principles, methodology, and expertise into existing procedures and infrastructure of multidisciplinary care in hematology clinics. Achieving this goal requires the close collaboration or even incorporation of multiple new professions in the hematology clinic in order to meet the needs of older patients with hematological malignancies who also have comorbidities and functional impairments. We here review the rationale, current evidence, and practical approaches of integrating geriatric oncology into multidisciplinary care in the hematology clinic.
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Affiliation(s)
- Valentin Goede
- Oncogeriatric Unit, Dept. of Geriatric Medicine, St. Marien Hospital, Cologne, Germany.
| | - Reinhard Stauder
- Dept. of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
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14
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Affiliation(s)
- Andrea Martoni
- UO Oncologia Medica, Policlinico S Orsola-Malpighi, Bologna, Italy.
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15
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Kochi M, Hinoi T, Niitsu H, Ohdan H, Konishi F, Kinugasa Y, Kobatake T, Ito M, Inomata M, Yatsuoka T, Ueki T, Tashiro J, Yamaguchi S, Watanabe M. Risk factors for postoperative pneumonia in elderly patients with colorectal cancer: a sub-analysis of a large, multicenter, case-control study in Japan. Surg Today 2018; 48:756-764. [PMID: 29594413 DOI: 10.1007/s00595-018-1653-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Postoperative pneumonia affects the length of stay and mortality after surgery in elderly patients with colorectal cancer (CRC). We aimed to determine the risk factors of postoperative pneumonia in elderly patients with CRC, and to evaluate the impact of laparoscopic surgery on elderly patients with CRC. METHODS We retrospectively investigated 1473 patients ≥ 80 years of age who underwent surgery for stage 0-III CRC between 2003 and 2007. Using a multivariate analysis, we determined the risk factors for pneumonia occurrence from each baseline characteristic. RESULTS Among all included patients, 26 (1.8%) experienced postoperative pneumonia, and restrictive respiratory impairment, obstructive respiratory impairment, history of cerebrovascular events, and open surgery were determined as risk factors (odds ratio [95% confidence interval], 2.78 [1.22-6.20], 2.71 [1.22-6.30], 3.60 [1.37-8.55], and 3.57 [1.22-15.2], respectively). Furthermore, postoperative pneumonia was more frequently accompanied by increasing cumulative numbers of these risk factors (area under the receiver operating characteristic curve = 0.763). CONCLUSIONS Laparoscopic surgery may be safely performed in elderly CRC patients, even those with respiratory impairment and a history of cerebrovascular events.
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Affiliation(s)
- Masatoshi Kochi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Takao Hinoi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan. .,Department of Surgery, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chu-goku Cancer Center, 3-1, Aoyama-cho, Kure-shi, Hiroshima, 737-0023, Japan.
| | - Hiroaki Niitsu
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Fumio Konishi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Ohmiya-ku, Saitama, 330-8503, Japan.,Department of Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima, Tokyo, 179-0072, Japan
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.,Department of Gastroenterological Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takaya Kobatake
- Department of Surgery, Division of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Center, 160 Koh, Umemotomachi, Matsuyama, Ehime, 791-0280, Japan
| | - Masaaki Ito
- Division of Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hazama-cho, Yufu, Oita, 879-5593, Japan
| | - Toshimasa Yatsuoka
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Inamachi, Kita-Adachi-gun, Saitama, 362-0806, Japan.,Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Takashi Ueki
- Department of Surgery and Oncology, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Gastroenterological Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Jo Tashiro
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
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Chang WP, Smith R, Lin CC. Age and rest–activity rhythm as predictors of survival in patients with newly diagnosed lung cancer. Chronobiol Int 2017; 35:188-197. [DOI: 10.1080/07420528.2017.1391278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Wen-Pei Chang
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- FAAN, Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pokfulam, Hong Kong
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17
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Abstract
BACKGROUND The management of elderly patients with cancer is influenced by several factors that can vary widely among aging individuals. As the proportion of elderly individuals increases, the need for specific care guidelines for this population is critical. The National Comprehensive Cancer Network (NCCN) has developed guidelines to address these factors when formulating optimal treatment regimens for elderly patients and to avoid significant toxicity and maintain their quality of life. METHODS Factors that influence the appropriate treatment choices for the elderly, such as functional status, comorbidity, polypharmacy, and the presence of anemia, are reviewed, and the guidelines developed by the NCCN for treatment elderly patients are discussed. RESULTS The guidelines address these factors when defining the goal of therapy and formulating individualized treatment approaches for the elderly to provide optimal care for these patients, avoid significant toxicity, and maintain their quality of life. CONCLUSIONS The goal of therapy must be clearly defined, whether survival, remission, cure, or palliation of symptoms. Enrollment of elderly cancer patients onto clinical trials is encouraged so the guidelines can be validated.
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Affiliation(s)
- Stuart M Lichtman
- Don Monti Division of Medical Oncology, North Shore University Hospital, Manhasset, NY 11030, USA.
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18
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Bilir C, Durak S, Kızılkaya B, Hacıbekiroglu I, Nayır E, Engin H. Efficacy of metronomic vinorelbine in elderly patients with advanced non-small-cell lung cancer and poor performance status. ACTA ACUST UNITED AC 2017; 24:e199-e204. [PMID: 28680287 DOI: 10.3747/co.24.3486] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Metronomic chemotherapy-administration of low-dose chemotherapy-allows for a prolonged treatment duration and minimizes toxicity for unfit patients diagnosed with advanced non-small-cell lung cancer (nsclc). METHODS Oral metronomic vinorelbine at 30 mg thrice weekly was given to 35 chemotherapy-naïve patients who were elderly and vulnerable to toxicity and who had been diagnosed with advanced nsclc. RESULTS Median age in this male-predominant cohort (29:6) was 76 years (range: 65-86 years). Histology was squamous cell carcinoma in 21 patients and adenocarcinoma in 14. There were no complete responses and 9 partial responses, for an overall response rate of 26%. Stable disease was seen in 15 patients (43%), and 11 patients (31%) had progressive disease. The 1-year survival rate was 34%, and the 2-year survival rate was 8%. The survival analysis showed a median progression-free survival duration of 4 months (range: 2-15 months) and an overall survival duration of 7 months (range: 3-24 months). CONCLUSIONS Metronomic vinorelbine had an acceptable efficacy and safety profile in elderly patients with multiple comorbidities who had been diagnosed with advanced nsclc. Metronomic vinorelbine could be a treatment option for elderly patients with poor performance status who are unfit for platinum-based chemotherapy and intravenous single-agent chemotherapy, and who are not candidates for combination modalities.
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Affiliation(s)
- C Bilir
- Department of Medical Oncology, Faculty of Medicine, Sakarya University, Sakarya
| | - S Durak
- Department of Internal Medicine, Faculty of Medicine, Recep Tayyip Erdogan University, Rize
| | - B Kızılkaya
- Department of Internal Medicine, Faculty of Medicine, Recep Tayyip Erdogan University, Rize
| | - I Hacıbekiroglu
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne
| | - E Nayır
- Department of Medical Oncology, Necip Fazıl City Hospital, Kahramanmaras; and
| | - H Engin
- Department of Medical Oncology, Faculty of Medicine, Sakarya University, Sakarya
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19
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Tosoian JJ, Alam R, Gergis C, Narang A, Radwan N, Robertson S, McNutt T, Ross AE, Song DY, DeWeese TL, Tran PT, Walsh PC. Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease. Prostate Cancer Prostatic Dis 2017; 20:193-196. [PMID: 28045113 PMCID: PMC5429182 DOI: 10.1038/pcan.2016.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/17/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer. METHODS Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer. RESULTS PSA-testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0% vs 51.6%, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95% confidence interval 1.96-5.87, P<0.001) as compared to the tested population. CONCLUSIONS Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.
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Affiliation(s)
- Jeffrey J. Tosoian
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol Gergis
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol Narang
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Noura Radwan
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott Robertson
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley E. Ross
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Danny Y. Song
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Theodore L. DeWeese
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phuoc T. Tran
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiation Oncology and Molecular Radiation Sciences at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick C. Walsh
- The James Buchanan Brady Urological Institute and Department of Urology at the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Gero-Oncology. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Outcomes in elderly patients treated with a single-agent or combination regimen as first-line chemotherapy for recurrent or metastatic gastric cancer. Gastric Cancer 2015; 18:644-52. [PMID: 25098925 DOI: 10.1007/s10120-014-0405-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Palliative chemotherapy is used to prolong survival among elderly patients with inoperable gastric cancer (GC). We analyzed differences between single and combination first-line palliative chemotherapy among these patients. METHODS Included patients were >70 years old and were treated for GC at four clinical centers of the Catholic University of Korea. Baseline characteristics, the first-line chemotherapy regimen, treatment responses, toxicities, progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS Between 2005 and 2012, 178 > 70-year-old patients with GC received palliative chemotherapy using single or combination regimens. Median ages were 77 years (range 71-89) in the single regimen group (SG, 70 patients) and 73 years (range 71-81) in the combination group (CG, 108 patients). Patients in the SG received S-1 or capecitabine. The most common regimen in the CG was platinum combined with fluorouracil. The most common response in both groups was stable disease (SG, 45.7 %; CG, 48.1 %). In the SG and CG, median PFS times were 4.4 months (95 % confidence interval [CI] 2.85-5.95) and 4.1 months (95 % CI 2.62-5.57; P = 0.295), respectively; median OS times were 6.6 months (95 % CI 4.17-9.08) and 7.6 months (95 % CI 5.50-9.69; P = 0.782), respectively. Hematologic (P < 0.001) and non-hematologic toxicities (P < 0.001) were more frequent in the CG. The most common causes of chemotherapy cessation were disease progression in the SG and decreased performance status in the CG. CONCLUSIONS Single-agent treatment should be considered a first-line palliative chemotherapy option for elderly patients with GC.
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22
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First-line treatment of newly diagnosed elderly patients with chronic myeloid leukemia: current and emerging strategies. Drugs 2015; 74:627-43. [PMID: 24711014 DOI: 10.1007/s40265-014-0207-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chronic myeloid leukemia (CML) is a disease of the hematopoietic stem cell characterized by a median age at diagnosis of 60-65 years according to most epidemiologic registries. Prior to the tyrosine kinase inhibitor (TKI) era, older age was considered an adverse prognostic factor and was included in two of the most used scoring systems for CML, the Sokal score and the Euro score. Moreover, older age was generally considered a limitation for the use of allogeneic stem-cell transplantation, given the higher toxicity observed. After the introduction of TKIs, age lost much of its prognostic impact in patients in chronic phase (CP), and the EUTOS score, developed in patients treated with imatinib, did not identify age as a risk variable. However, most CML patients require life-long treatment; therefore, as patients age while taking a TKI, the complexity of the management of elderly patients may increase over time. To date, imatinib, the first TKI introduced, and two second-generation TKIs, nilotinib and dasatinib, have been approved in most Western countries for the first-line treatment of CML. These drugs differ in terms of efficacy, safety, and costs; therefore, knowledge of their characteristics is extremely relevant for optimal management of elderly CML patients. We reviewed the impact of age on the first-line treatment of CP CML patients in the TKI era, considering the epidemiology of the disease, the role of comorbidities, and analyzing data from population-based studies and clinical trials.
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23
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Camerini A, Puccetti C, Donati S, Valsuani C, Petrella MC, Tartarelli G, Puccinelli P, Amoroso D. Metronomic oral vinorelbine as first-line treatment in elderly patients with advanced non-small cell lung cancer: results of a phase II trial (MOVE trial). BMC Cancer 2015; 15:359. [PMID: 25943747 PMCID: PMC4424528 DOI: 10.1186/s12885-015-1354-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metronomic oral vinorelbine could be a safe option for elderly patients with advanced non small cell lung cancer (NSCLC). Metronomic administration of chemotherapy leads to a cytostatic action shifting treatment target from cancer cell to tumor angiogenesis. METHODS 43 chemotherapy naive elderly (≥ 70 yrs) PS 0-2 patients with stage IIIB-IV NSCLC were prospectively recruited. Median age was 80 yrs (M/F 36/7) with predominantly squamous histology. PS distribution was 0-1(16)/2(27) with a median of 3 serious co-morbid illnesses. Study treatment consisted of oral vinorelbine 50mg three times weekly (Monday-Wednesday-Friday) continuously until disease progression, unacceptable toxicity or patient refusal. Primary endpoints were overall response rate (ORR), clinical benefit (CB--disease response plus disease stabilization >12 weeks) and safety. Health-related QoL (HRQoL) was also assessed with FACT-L V4 scoring questionnaire. We conducted an exploratory time-course analysis of VEGF and thrombospondin-1 (TSP1) serum levels in a subgroup of patients. RESULTS Patients received a median of 5 (range 1-21) cycles with a total of 272 cycles delivered. ORR was 18.6% with 7 partial and 1 complete responses; 17/43 experienced stable disease lasting more than 12 weeks leading to an overall CB of 58.1%. Median time to progression was 5 (range 2-21) and median overall survival 9 (range 3-29) months. Treatment was well tolerated with rare serious toxicity. Regardless of severity main toxicities observed were anemia in 44%, fatigue in 32.4%, and diarrhoea 10.5%. FACT-L v4 scores did not significantly vary during treatment. Baseline VEGF levels were lower and showed a rapid increase during treatment in non-responders pts only while TSP1 levels did not change. CONCLUSIONS Metronomic oral vinorelbine is safe in elderly patients with advanced NSCLC with an interesting activity mainly consisting in long-term disease stabilization coupled with an optimal patient compliance (Eudra-CT 2010-018762-23, AIFA OSS on 26 February 2010).
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Affiliation(s)
- Andrea Camerini
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy.
| | - Cheti Puccetti
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy.
| | - Sara Donati
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy.
| | - Chiara Valsuani
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy.
| | | | - Gianna Tartarelli
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy.
| | - Paolo Puccinelli
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy.
| | - Domenico Amoroso
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy.
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Ferreira DB, Mattos IE. Trends in mortality due to breast cancer among women in the state of Rio de Janeiro, Brazil, 1996-2011. CIENCIA & SAUDE COLETIVA 2015; 20:895-903. [DOI: 10.1590/1413-81232015203.07982014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022] Open
Abstract
A descriptive time series study was conducted in order to analyze the mortality rates for breast cancer in two age brackets (< 60 years and ≥ 60 years), in areas of the state of Rio de Janeiro (inland, metropolitan area, capital and state). The data source was the Mortality Information System. Mortality rates were analyzed for four-year periods, between 1996 and 2011, and the ratios between the incidences for the two age brackets in each area. The trend in annual mortality rates was analyzed with the Joinpoint program and polynomial regression models. The ratios between the incidences observed were 7-8 times higher in women aged 60 years or older. Joinpoint analyses indicated a linear decline in mortality rates in the state and the capital for the whole population and for women aged 60 and over in the same areas. The polynomial regression models allowed the observation of periods of increasing and decreasing rates and a tendency to stabilization at the end of the period. Despite the declining trend, the magnitude of mortality from breast cancer is still high among women aged 60 and older, and it is important to investigate associated factors in this population group.
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Lycke M, Pottel L, Boterberg T, Ketelaars L, Wildiers H, Schofield P, Weller D, Debruyne P. Integration of geriatric oncology in daily multidisciplinary cancer care: the time is now. Eur J Cancer Care (Engl) 2015; 24:143-6. [DOI: 10.1111/ecc.12301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M. Lycke
- Cancer Centre; General Hospital Groeninge; Kortrijk Belgium
| | - L. Pottel
- Cancer Centre; General Hospital Groeninge; Kortrijk Belgium
| | - T. Boterberg
- Department of Radiation Oncology; Ghent University Hospital; Ghent Belgium
| | - L. Ketelaars
- Department of Psycho-oncology; General Hospital Groeninge; Kortrijk Belgium
| | - H. Wildiers
- Department of General Medical Oncology & Leuven Cancer Institute; Leuven University Hospital; Leuven Belgium
| | - P. Schofield
- Centre for Positive Ageing; University of Greenwich; London UK
| | - D. Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
| | - P.R. Debruyne
- Cancer Centre; General Hospital Groeninge; Kortrijk Belgium
- Centre for Positive Ageing; University of Greenwich; London UK
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Yun HG. An 87-year-old patient with repeated oligorecurrences over six years whose disease were treated with radiotherapy alone. Radiat Oncol J 2015; 32:266-71. [PMID: 25568856 PMCID: PMC4283002 DOI: 10.3857/roj.2014.32.4.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/12/2014] [Accepted: 09/30/2014] [Indexed: 11/07/2022] Open
Abstract
In the clinical state of oligometastases or oligorecurrence, a transitional state between localized and widespread systemic disease, local control of the disease may yield improved systemic control. Radiotherapy may be a good means for controlling oligometastatic tumors, particularly in very old patients for whom surgery may be infeasible. A combination of systemic therapy and local therapy is necessary to prevent systemic progression. Some kinds of cancers found in the elderly are known to be somewhat indolent for systemic progression. So, for very old patients who refuse or cannot tolerate chemotherapy, the use of radical radiotherapy alone to treat oligorecurrences may be very helpful. We successfully treated an 87-year-old patient who had been diagnosed with oligorecurrences three times over six years with radiotherapy alone. The patient is now, about four years after his first radiotherapy for liver metastasis, alive without any evidence of cancer and with fully active performance status.
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Affiliation(s)
- Hyong Geun Yun
- Department of Radiation Oncology, Dongguk University Ilsan Hospital, Goyang, Korea
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Lung transplantation with lungs from older donors: recipient and surgical factors affect outcomes. Transplantation 2014; 98:903-8. [PMID: 24825527 DOI: 10.1097/tp.0000000000000134] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A shortage of donors has compelled the use of extended-criteria donor organs in lung transplantation. The purpose of this study was to evaluate the impact of using older donors on outcomes after lung transplantation using current protocols. METHODS From January 2003 to August 2009, 593 lung transplants were performed at our institution. We compared 87 patients (14.7%) who received lungs from donors aged 55 years or older with 506 patients who received lungs from donors less than 55 years old. We also examined risk factors for mortality in recipients of lungs from older donors. RESULTS The incidence of major complications including severe primary graft dysfunction and early mortality rates were similar between the groups. However, posttransplant peak FEV1 was lower in the patients who received lungs from older donors (71.7% vs. 80.7%, P<0.05). In multivariate analysis, recipient pulmonary hypertension (transpulmonary pressure gradient >20 mm Hg) and prolonged intraoperative cardiopulmonary bypass were significant risk factors for mortality in the recipients of lungs from older donors. CONCLUSIONS This large, single-center experience demonstrated that transplanting lungs from donors older than 55 years did not yield worse short- or long-term outcomes as compared with transplanting lungs from younger donors. However, transplanting lungs from older donors into recipients with pulmonary hypertension or recipients who required prolonged cardiopulmonary bypass increased the risk for mortality. Although lungs from older donors should not be excluded because of donor age alone, surgeons should carefully consider their patient selection criteria and surgical plans when transplanting lungs from older donors.
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Bouchlaka MN, Murphy WJ. Impact of aging in cancer immunotherapy: The importance of using accurate preclinical models. Oncoimmunology 2013; 2:e27186. [PMID: 24498569 PMCID: PMC3909540 DOI: 10.4161/onci.27186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 11/13/2013] [Indexed: 01/03/2023] Open
Abstract
Cancer immunotherapy holds great promise, yet its efficacy and applicability can be hampered by the rise of systemic toxicities. We have recently shown that the lethal side effects of cancer immunotherapy are markedly exacerbated with aging. Blocking tumor necrosis factor α or macrophages can alleviate the systemic toxicity of immunotherapy while preserving its antineoplastic effects.
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Affiliation(s)
- Myriam N Bouchlaka
- Department of Dermatology; University of California; Davis School of Medicine; Sacramento, CA USA
| | - William J Murphy
- Department of Dermatology; University of California; Davis School of Medicine; Sacramento, CA USA ; Department of Internal Medicine; University of California; Davis School of Medicine; Sacramento, CA USA
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Sigel K, Lurslurchachai L, Bonomi M, Mhango G, Bergamo C, Kale M, Halm E, Wisnivesky J. Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer. Lung Cancer 2013; 82:266-70. [PMID: 24011407 PMCID: PMC3845375 DOI: 10.1016/j.lungcan.2013.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/12/2013] [Accepted: 06/24/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE Chemoradiotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). Elderly patients, who are often considered unfit for combined chemoradiotherapy, frequently receive radiation therapy (RT) alone. Using population-based data, we evaluated the effectiveness and tolerability of lone RT in unresected elderly stage III NSCLC patients. METHODS AND MATERIALS Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare records we identified 10,376 cases of unresected stage III NSCLC that were not treated with chemotherapy, diagnosed between 1992 and 2007. We used logistic regression to determine propensity scores for RT treatment using patients' pre-treatment characteristics. We then compared survival of patients who underwent lone RT vs. no treatment using a Cox regression model adjusting for propensity scores. The adjusted odds for toxicity among patients treated with and without RT were also estimated. RESULTS Overall, 6468 (62%) patients received lone RT. Adjusted analyses showed that RT was associated with improved overall survival in unresected stage III NCSLC (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.74-0.79) after controlling for propensity scores. RT treated patients had an increased adjusted risk of hospitalization for pneumonitis (odds ratio [OR]: 89, 95% CI: 12-636), and esophagitis (OR: 8, 95% CI: 3-21). CONCLUSIONS These data suggest that use of RT alone may improve the outcomes of elderly patients with unresected stage III NSCLC. Severe toxicity, however, was considerably higher in the RT treated group. The potential risks and benefits of RT should be carefully discussed with eligible elderly NSCLC patients.
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Affiliation(s)
- Keith Sigel
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, United States.
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Bouchlaka MN, Sckisel GD, Chen M, Mirsoian A, Zamora AE, Maverakis E, Wilkins DEC, Alderson KL, Hsiao HH, Weiss JM, Monjazeb AM, Hesdorffer C, Ferrucci L, Longo DL, Blazar BR, Wiltrout RH, Redelman D, Taub DD, Murphy WJ. Aging predisposes to acute inflammatory induced pathology after tumor immunotherapy. ACTA ACUST UNITED AC 2013; 210:2223-37. [PMID: 24081947 PMCID: PMC3804937 DOI: 10.1084/jem.20131219] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aging strongly promotes inflammation responses, which may predispose individuals after cancer therapies to lethal system toxicities and pathology that can be partially prevented by TNF blockade. Cancer commonly occurs in the elderly and immunotherapy (IT) is being increasingly applied to this population. However, the majority of preclinical mouse tumor models assessing potential efficacy and toxicities of therapeutics use young mice. We assessed the impact of age on responses to systemic immune stimulation. In contrast to young mice, systemic cancer IT regimens or LPS given to aged mice resulted in rapid and lethal toxicities affecting multiple organs correlating with heightened proinflammatory cytokines systemically and within the parenchymal tissues. This inflammatory response and increased morbidity with age was independent of T cells or NK cells. However, prior in vivo depletion of macrophages in aged mice resulted in lesser cytokine levels, increased survival, and decreased liver histopathology. Furthermore, macrophages from aged mice and normal human elderly volunteers displayed heightened TNF and IL-6 production upon in vitro stimulation. Treatment of both TNF knockout mice and in vivo TNF blockade in aged mice resulted in significant increases in survival and lessened pathology. Importantly, TNF blockade in tumor-bearing, aged mice receiving IT displayed significant anti-tumor effects. These data demonstrate the critical role of macrophages in the age-associated hyper-inflammatory cytokine responses to systemic immunostimulation and underscore the importance of performing preclinical assessments in aged mice.
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Affiliation(s)
- Myriam N Bouchlaka
- Department of Microbiology & Immunology and 2 Department of Physiology and Cell Biology, University of Nevada-Reno School of Medicine, Reno, NV 89557
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Catalano V, Bisonni R, Graziano F, Giordani P, Alessandroni P, Baldelli AM, Casadei V, Rossi D, Fedeli SL, D'Emidio S, Giustini L, Fiorentini G. A phase II study of modified FOLFOX as first-line chemotherapy for metastatic gastric cancer in elderly patients with associated diseases. Gastric Cancer 2013; 16:411-9. [PMID: 23065042 DOI: 10.1007/s10120-012-0204-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/23/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elderly patients are generally underrepresented in the study populations of combination chemotherapy trials. This study evaluates the efficacy and safety of a modified FOLFOX regimen in elderly patients with metastatic gastric cancer and presenting associated disease(s). METHODS A total of 43 patients aged ≥70 years received oxaliplatin 85 mg/m(2) together with 6S-leucovorin 200 mg/m(2) on day 1, followed by a 46-h infusion of 5-fluorouracil 2,400 mg/m(2), every 2 weeks. Assessment of response was performed every four cycles according to RECIST criteria. RESULTS Median patient age was 74 years (range, 70-83 years). Overall response rate was 34.9% [95% confidence interval (CI), 20.6-49.1, with 3 complete responses and 12 partial responses. Grade 3 neutropenia occurred in 4 patients (9.3%), fatigue in 3 patients (7.0%), and vomiting in 2 patients (4.6%). Grade 2 and 3 peripheral neuropathy was observed in 5 patients (11.6%) and 1 patient (2.3%), respectively. No treatment-related death was observed. Median progression-free and overall survival were 6.8 and 10.5 months, respectively. CONCLUSIONS This modified FOLFOX regimen is an active and well-tolerated treatment for elderly patients with metastatic gastric cancer and also represents a good therapeutic option in patients with associated disease(s).
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Affiliation(s)
- Vincenzo Catalano
- U.O.C. Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio San Salvatore, Via Lombroso, 61122, Pesaro, Italy.
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Liu HC, Huang WC, Wu CL, Huang JT, Chen CH, Chen YJ. Surgery for Elderly Lung Cancer. Ann Thorac Cardiovasc Surg 2013; 19:416-22. [DOI: 10.5761/atcs.oa.12.02040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Luce S, De Breucker S, Van Gossum A, Demols A, Mekinda Z, Ena G, Kentos A, Roumeguère T, Ghanooni R, Nouwynck C, Van Laethem JL, Sokolow Y, Simon P, Bailly B, Vervaet C, Marchand M, Pepersack T. How to identify older patients with cancer who should benefit from comprehensive geriatric assessment? J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Atagi S, Kawahara M, Yokoyama A, Okamoto H, Yamamoto N, Ohe Y, Sawa T, Ishikura S, Shibata T, Fukuda H, Saijo N, Tamura T. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol 2012; 13:671-8. [DOI: 10.1016/s1470-2045(12)70139-0] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Are postoperative consequences of neoadjuvant chemotherapy for non-small cell lung cancer more severe in elderly patients? Lung Cancer 2012; 76:216-21. [DOI: 10.1016/j.lungcan.2011.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/14/2011] [Accepted: 10/16/2011] [Indexed: 11/24/2022]
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Kim ST, Park KH, Oh SC, Seo JH, Shin SW, Kim JS, Kim YH. Is chemotherapy in elderly patients with metastatic or recurrent gastric cancer as tolerable and effective as in younger patients? Asia Pac J Clin Oncol 2012; 8:194-200. [PMID: 22524579 DOI: 10.1111/j.1743-7563.2011.01501.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM To analyze the chemotherapy regimens and outcomes of advanced gastric cancer (AGC) patients older than 70 years of age. METHODS Between May 2001 and October 2009, 1135 patients with metastatic or recurrent gastric cancer received palliative chemotherapy. Of these patients 56 (4.9%) were ≥70 years old and were analyzed retrospectively. RESULTS The median age at the time of first-line chemotherapy was 73 years (range, 70-85) and the median Charlson comorbidity index was 0 (0-5). In all 17 patients (30%) received surgery with curative or palliative intent; 43 (77%) were treated by doublet or triplet first-line chemotherapy regimens and 13 patients (23%) received single agent chemotherapy. Median progression-free survival for first-line chemotherapy was 3.97 months (95% CI 2.05-5.89) with an overall response rate of 26%. After the first-line chemotherapy, only 18 of 56 (32%) patients received second-line chemotherapy. The median overall survival (OS) was 12.4 months (95% CI 2.81-21.99). In multivariate analysis, receiving surgery and disease control for first-line chemotherapy were independent prognostic factors for increased OS for all 56 patients. CONCLUSION Patients older ≥70 years with metastatic or recurrent gastric cancer might achieve clinical benefit from chemotherapy. Receiving surgery and response of over more stable disease for first-line chemotherapy were independent prognostic factors for increased OS.
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Affiliation(s)
- Seung Tae Kim
- Divisions of Hematology-Oncology, Korea University College of Medicine, Seoul, South Korea
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Rivera C, Dahan M, Bernard A, Falcoz PE, Thomas P. Surgical treatment of lung cancer in the octogenarians: results of a nationwide audit. Eur J Cardiothorac Surg 2011; 39:981-6. [DOI: 10.1016/j.ejcts.2010.09.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 09/01/2010] [Accepted: 09/05/2010] [Indexed: 10/18/2022] Open
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Bellury LM, Ellington L, Beck SL, Stein K, Pett M, Clark J. Elderly cancer survivorship: an integrative review and conceptual framework. Eur J Oncol Nurs 2011; 15:233-42. [PMID: 21530396 DOI: 10.1016/j.ejon.2011.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 03/22/2011] [Accepted: 03/25/2011] [Indexed: 12/27/2022]
Abstract
UNLABELLED The intersection of ageing and cancer in the phase of post-treatment survivorship represents a large and growing population with unique needs. PURPOSE The goal of this work is to review and integrate the current gerontology and oncology literature relevant to elderly cancer survivorship, to identify knowledge gaps and research opportunities and to propose a conceptual model to guide future research. The long-term, global goal is the prevention of morbidity and mortality in elderly cancer survivors by identification of vulnerable elders, maintenance of independence, tailoring of treatment, establishing intervention guidelines and planning for necessary resources within the entire trajectory of cancer survival for older survivors. METHODS Targeted and integrative review of selected literature from multiple disciplines. Search engines included PubMed, article reference lists and internet searches for epidemiological data (US Census, World Health Organization, American Cancer Society, Canadian Cancer Cancer Society, etc). RESULTS A conceptual model that incorporates the gerontologic, oncologic and personal characteristics of older cancer survivors is proposed that may provide a comprehensive approach by which to frame elderly survivorship research. CONCLUSION Cancer survivorship among the elderly is quantitatively and qualitatively different from cancer survivorship among other age groups. The current large numbers and predicted increase in elderly cancer survivors in the near future mandate attention to this population. Future research must consider the complexity of intersecting needs in the gero-oncology population.
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Gruschkus SK, Lairson D, Dunn JK, Risser J, Du XL. Use of white blood cell growth factors and risk of acute myeloid leukemia or myelodysplastic syndrome among elderly patients with non-Hodgkin lymphoma. Cancer 2011; 116:5279-89. [PMID: 20665502 DOI: 10.1002/cncr.25525] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The current study was conducted to evaluate the association between colony-stimulating factor (CSF) use and the risk of developing therapy-related myelodysplastic syndromes or acute myeloid leukemia (t-MDS/AML) among a large cohort of elderly patients with non-Hodgkin lymphoma (NHL) who were treated with chemotherapy. METHODS A total of 13,203 NHL patients were identified from the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed from 1992 through 2002. Patients were followed from their initial chemotherapy date until the date they were diagnosed with t-MDS/AML, death, or last follow-up (October 31, 2006), whichever occurred first. RESULTS Overall, 40% (n = 5266) of patients received CSF. During the follow-up period (median follow-up, 2.9 years [range, 1-14.7 years]), 272 (5.2%) patients who were treated with CSF developed t-MDS/AML, compared with 230 (2.9%) patients who did not (P < .0001, log-rank test). The 5-year incidence of t-MDS/AML for patients receiving CSF was 14.1 per 1000 person-years compared with 8.3 per 1000 person-years for patients not receiving CSF. In a multivariable Cox regression analysis adjusted for gender, histology, stage, comorbidities, radiotherapy, and chemotherapy agent, CSF use was found to be independently associated with a 53% increased risk of t-MDS/AML (hazard ratio [HR], 1.53; 95% confidence interval [95% CI], 1.26-1.84). The observed association between CSF use and t-MDS/AML persisted across histologic subgroups (ie, diffuse large B-cell lymphoma, follicular lymphoma, and others). Patients who received both CSF and antimetabolite chemotherapy were found to have a 2.5-fold increased risk of t-MDS/AML (HR, 2.49; 95% CI, 1.91-3.26) compared with patients who received neither agent. CONCLUSIONS The current study, which to our knowledge is the first large population-based study published to date, demonstrated that the administration of CSF among elderly NHL patients receiving chemotherapy was associated with an increased risk of t-MDS/AML, although the absolute risk was low.
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Liu HC, Chen YC, Chen CH, Chen YJ. Esophagectomy in Elderly Patients With Esophageal Cancer. INT J GERONTOL 2010. [DOI: 10.1016/j.ijge.2010.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Safety and efficacy of S-1 monotherapy in elderly patients with advanced gastric cancer. Gastric Cancer 2010; 13:245-50. [PMID: 21128060 DOI: 10.1007/s10120-010-0566-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 07/06/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although S-1 is effective against advanced gastric cancer (AGC), its efficacy in elderly patients has not yet been investigated sufficiently. We assessed the efficacy and safety of S-1 monotherapy in elderly patients with AGC. METHODS We conducted a retrospective review of the data of 153 patients with unresectable/recurrent gastric adenocarcinoma who received S-1 monotherapy as first-line chemotherapy at our institution. S-1 was administered orally twice daily at the dose of 40 mg/m², on days 1-28, every 6 weeks. We categorized the patients into three groups, the young (≤65 years old), the middle-aged (66-75 years old), and the elderly (≥76 years old); and the drug toxicity, objective responses, progression-free survivals, and overall survivals were compared among the three groups. RESULTS The incidence of leukopenia of grade 3 or greater in the three groups was 7%, 5%, and 13%, and that of anemia was 9%, 18%, and 27%, respectively. In regard to nonhematological toxicities, the incidence of nausea of grade 3 or greater was 3%, 5%, and 13%; that of fatigue was 5%, 11%, and 20%; and that of anorexia was 5%, 6%, and 27%, respectively. As for the treatment efficacy, the objective response rates, median progressionfree survivals, and overall survivals in the young, middle-aged, and elderly groups were 53%, 46%, and 33%; 7.8, 5.6, and 3.9 months; and 16.9, 17.1; and 7.7 months, respectively. CONCLUSION Although S-1 monotherapy showed moderate efficacy in elderly (≥76 years) patients with AGC, patients in this age group showed higher incidences of severe toxicities than the younger patients.
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Rousseau F, Retornaz F, Joly F, Esterni B, Abadie-Lacourtoisie S, Fargeot P, Luporsi E, Servent V, Laguerre B, Brain E, Geneve J. Impact of an all-oral capecitabine and vinorelbine combination regimen on functional status of elderly patients with advanced solid tumours: A multicentre pilot study of the French geriatric oncology group (GERICO). Crit Rev Oncol Hematol 2010; 76:71-8. [DOI: 10.1016/j.critrevonc.2009.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 11/30/2009] [Accepted: 12/16/2009] [Indexed: 11/16/2022] Open
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Gruschkus SK, Lairson D, Dunn JK, Risser J, Du XL. Comparative effectiveness of white blood cell growth factors on neutropenia, infection, and survival in older people with non-Hodgkin's lymphoma treated with chemotherapy. J Am Geriatr Soc 2010; 58:1885-95. [PMID: 20840455 DOI: 10.1111/j.1532-5415.2010.03081.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the effect of colony-stimulating factor (CSF) on incidence of febrile neutropenia, infection, and survival in older people with non-Hodgkin's lymphoma (NHL) treated with chemotherapy. DESIGN Retrospective cohort study. SETTING The Surveillance, Epidemiology, and End Results-Medicare database. PARTICIPANTS Thirteen thousand two hundred twenty-three people diagnosed with NHL at age 65 and older (mean age 74.9, range 65-102) in 1992 to 2002 who received chemotherapy within 12 months of diagnosis. MEASUREMENTS Primary prophylaxis was defined as CSF administered at the start of chemotherapy before febrile neutropenia or infection; secondary prophylaxis was defined as CSF use after febrile neutropenia or infection. RESULTS Participants with five to nine administrations of primary prophylactic CSF had a 42% lower risk of febrile neutropenia (odds ratio (OR)=0.58, 95% confidence interval (CI)=0.41-0.83), and participants with 10 or more administrations had a 48% lower risk (OR=0.52, 95% CI=0.36-0.76) after adjusting for age, stage, histology, and comorbidity. Results did not differ significantly after adjusting for propensity score of receiving CSF. There was no significant association between primary prophylactic CSF and overall survival, but secondary prophylactic CSF was significantly associated with better survival. Four to 10 administrations of secondary prophylactic CSF was associated with 9% lower mortality risk (hazard ratio (HR)=0.91, 95% CI=0.84-0.99), 11 to 23 administrations was associated with 23% lower mortality risk (HR=0.77, 95% CI=0.71-0.84) and 24 or more administrations was associated with 13% lower mortality risk (HR=0.87, 95% CI+0.79-0.95) than in participants not receiving CSF after neutropenia or infection. CONCLUSION Primary prophylactic CSF was observed to be effective in reducing the incidence of neutropenia and infection. These findings substantiate the clinical guidelines for recommending prophylactic CSF in older people with NHL receiving chemotherapy.
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Affiliation(s)
- Stephen K Gruschkus
- Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, Texas, USA
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Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata como medida de la calidad de vida de los pacientes con cáncer de próstata en España: aplicación a la actividad diaria. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kellen E, Bulens P, Deckx L, Schouten H, Van Dijk M, Verdonck I, Buntinx F. Identifying an accurate pre-screening tool in geriatric oncology. Crit Rev Oncol Hematol 2010; 75:243-8. [DOI: 10.1016/j.critrevonc.2009.12.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 10/28/2009] [Accepted: 12/10/2009] [Indexed: 12/27/2022] Open
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Wiggins CL, Harlan LC, Nelson HE, Stevens JL, Willman CL, Libby EN, Hromas RA. Age disparity in the dissemination of imatinib for treating chronic myeloid leukemia. Am J Med 2010; 123:764.e1-9. [PMID: 20670732 PMCID: PMC2913144 DOI: 10.1016/j.amjmed.2010.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/15/2010] [Accepted: 03/19/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Imatinib is a highly effective treatment for chronic myeloid leukemia. It was approved by the Food and Drug Administration in 2001 and thereafter rapidly became front-line therapy. This study characterized the prevailing chronic myeloid leukemia therapies in the United States and assessed the impact of imatinib on chronic myeloid leukemia survival and mortality rates in the general population. METHODS Investigators with the National Cancer Institute's Patterns of Care study reviewed medical records and queried physicians regarding therapy for 423 patients with chronic myeloid leukemia diagnosed in 2003 who were randomly selected from cancer registries in the Surveillance, Epidemiology, and End Results Program. Characteristics associated with the receipt of imatinib were documented, as were survival differences between those who received imatinib and those who did not. Population-based data were used to assess chronic myeloid leukemia survival and mortality rates in time periods before and after the introduction of imatinib. RESULTS Imatinib was administered to 76% of patients in the Patterns of Care study. Imatinib use was inversely associated with age: 90%, 75%, and 46% for patients ages 20 to 59 years, 60 to 79 years, and 80 or more years, respectively. Elderly patients who received imatinib survived significantly longer than those who did not. After adjusting for age, imatinib use did not vary significantly by race/ethnicity, socioeconomic status, urban/rural residence, presence of comorbid conditions, or insurance status. Overall, chronic myeloid leukemia survival in the Surveillance, Epidemiology, and End Results population improved, and mortality in the United States declined dramatically during the period when imatinib became widely available; these improvements diminished with increasing age. CONCLUSION Age disparities in treatment with imatinib likely contributed to worse survival for many elderly patients with chronic myeloid leukemia.
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Affiliation(s)
- Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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[Management of muscle invasive bladder in elderly]. Prog Urol 2010; 20 Suppl 1:S57-60. [PMID: 20493448 DOI: 10.1016/s1166-7087(10)70029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Elderly are often the population affected by bladder cancer. Physician must consider not only a patient's chronologic age but also physiologic age and associated medical conditions. Although radical cystectomy remains the treatment of choice for muscle invasive bladder cancer, it has a well-recognized risk of perioperative complications and mortality. Multidisciplinary oncogeriatric evaluation is necessary to detect associated comorbidities, and to improve oncologic decision and surgical outcomes. Radical cystectomy with ileal conduit is recommended in elderly. Indications of conservative treatments depend on local extension, haematuria, and metastasis.
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Radiotherapy for lung cancer in the elderly. Lung Cancer 2010; 68:129-36. [DOI: 10.1016/j.lungcan.2009.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 12/25/2022]
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Hammer MJ, Motzer SA, Voss JG, Berry DL. Glycemic control among older adult hematopoietic cell transplant recipients. J Gerontol Nurs 2010; 36:40-50. [PMID: 20047243 DOI: 10.3928/00989134-20091207-99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 08/26/2009] [Indexed: 12/23/2022]
Abstract
Adults age 55 and older with hematological malignancies who require hematopoietic cell transplantation (HCT) for survival are at risk for a number of nonmalignancy-related, potentially life-threatening outcomes, often due to suboptimal immune function. Evidence is emerging regarding how abnormal glycemic levels-newly termed malglycemia-impair cells of the immune system. Further, older adult HCT recipients appear highly susceptible to malglycemic states, particularly hyperglycemia, due to treatment regimens, nutritional imbalances, states of immobility, and stress, all coupled with the natural aging process. Patients with preexisting diabetes may be at further risk for malglycemic states. The growing number of older adults receiving HCT will substantially increase the likelihood nurses will have to provide care to HCT survivors. Therefore, it is important nurses in all practice settings have an understanding of the short-and long-term effects of glycemic status on immune function.
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Affiliation(s)
- Marilyn J Hammer
- New York University College of Nursing, New York, New York 10003, USA.
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Age has no significant impact on overall survival and on treatment tolerability in relapsed stage IV cutaneous malignant melanoma patients receiving Cisplatin, Gemcitabine, and Treosulfan. Am J Clin Oncol 2010; 34:2-5. [PMID: 20042970 DOI: 10.1097/coc.0b013e3181c4c531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We compared the efficacy and tolerability of cisplatin, gemcitabine, and treosulfan (CGT) therapy in younger patients (age, <60 years) and in elderly patients (age, ≥60 years) with pretreated relapsed American Joint Committee on Cancer stage IV cutaneous malignant melanoma. PATIENTS AND METHODS A total of 91 patients at the age of 18 to 80 years, in relapse after first-, second-, or third-line therapy received 40 mg/m intravenous (i.v.) cisplatin, 1000 mg/m i.v. gemcitabine, and 2500 mg/m i.v. treosulfan on days 1 and 8. CGT-therapy was repeated every 5 weeks until progression of disease occurred. RESULTS Younger (n = 49) and elderly (n = 42) patients showed a significant difference in disease stabilization in 25% versus 7% (P ≤ 0.05), as opposed to 69% versus 91% patients exhibiting disease progression. In contrast, the overall median survival probability was not significantly different (P = 0.8153). Neither treatment-related toxicity nor toxicity-associated dose reduction showed substantial differences. CONCLUSIONS Our results demonstrated that CGT therapy could be safely administered to a patient up to age 80 years.
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