1
|
Meng D, Guo L, Shi D, Sun X, Shang M, Xiao S, Zhou X, Zhao Y, Wang X, Li J. Dual-sensitive and highly biocompatible O-carboxymethyl chitosan nanodroplets for prostate tumor ultrasonic imaging and treatment. Cancer Nanotechnol 2023. [DOI: 10.1186/s12645-023-00172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
Abstract
AbstractNanosized drug delivery systems have rapidly emerged as a promising approach to tumor therapy, which still have many challenges in clinical application. In this study, doxorubicin-loaded O-carboxymethyl chitosan/perfluorohexane nanodroplets (O-CS-DOX NDs) were synthesized and functionally tested as an effective drug delivery system in vitro and in vivo. O-CS-DOX NDs with small size (159.6 nm) and good doxorubicin encapsuling ability showed pH- and ultrasound-dependent drug release profile and satisfying ultrasound imaging performance. With high biocompatibility and biosafety, these nanodroplets could accumulate in the tumor sites and exhibit high efficiency in inhibiting tumor growth with ultrasound irradiation. These stable, safe and smart O-CS-DOX NDs showed promising potential as a smart dual-responsive bomb for tumor ultrasonic imaging and treatment.
Collapse
|
2
|
Haapasalmi S, Piili RP, Metsänoja R, Kellokumpu-Lehtinen PLI, Lehto JT. Physicians' decreased tendency to choose palliative care for patients with advanced dementia between 1999 and 2015. BMC Palliat Care 2021; 20:119. [PMID: 34311739 PMCID: PMC8312352 DOI: 10.1186/s12904-021-00811-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Physicians’ decision-making for seriously ill patients with advanced dementia is of high importance, especially as the prevalence of dementia is rising rapidly, and includes many challenging ethical, medical and juridical aspects. We assessed the change in this decision-making over 16 years (from 1999 to 2015) and several background factors influencing physicians’ decision. Methods A postal survey including a hypothetical patient-scenario representing a patient with an advanced dementia and a life-threatening gastrointestinal bleeding was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. The target groups were general practitioners (GPs), surgeons, internists and oncologists. The respondents were asked to choose between several life-prolonging and palliative care approaches. The influence of physicians’ background factors and attitudes on their decision were assessed. Results The response rate was 56%. A palliative care approach was chosen by 57 and 50% of the physicians in 1999 and 2015, respectively (p = 0.01). This change was statistically significant among GPs (50 vs 40%, p = 0.018) and oncologists (77 vs 56%, p = 0.011). GPs chose a palliative care approach less often than other responders in both years (50 vs. 63% in 1999 and 40 vs. 56% in 2015, p < 0.001). In logistic regression analysis, responding in 2015 and being a GP remained explanatory factors for a lower tendency to choose palliative care. The impact of family’s benefit on the decision-making decreased, whereas the influence of the patient’s benefit and ethical values as well as the patient’s or physician’s legal protection increased from 1999 to 2015. Conclusions Physicians chose a palliative care approach for a patient with advanced dementia and life-threatening bleeding less often in 2015 than in 1999. Specialty, attitudes and other background factors influenced significantly physician decision-making. Education on the identification and palliative care of the patients with late-stage dementia are needed to make these decisions more consistent.
Collapse
Affiliation(s)
- Saila Haapasalmi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. .,Palliative Care Centre and Department of Geriatrics, Tampere University Hospital, Tampere, Finland. .,Tays Hatanpää Hospital, Hatanpäänkatu 24, T-Building, 4th floor, 33900, Tampere, Finland.
| | - Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Riina Metsänoja
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pirkko-Liisa I Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
3
|
Monteiro AR, Conde RS, Basto R, Sclafani F, Deleporte A, Hendlisz A, Dal Lago L. Targeted agents in older patients with gastrointestinal cancers - An overview. J Geriatr Oncol 2021; 12:1240-1252. [PMID: 34226158 DOI: 10.1016/j.jgo.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/12/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022]
Abstract
Targeted agents have been increasingly used in different malignancies and are associated with improved survival outcomes, including gastrointestinal cancers. Their use in the treatment of older patients is appealing given their favorable toxicity profile. In the last years, this subgroup of patients has been attracting increased interest given their representativeness and specific clinical needs. Nonetheless, the lack of data on efficacy and safety of standard treatments in older patients hinders proper evidence-based decision-making, leaving most therapeutic recommendations to be extrapolated from registration trials with low representation of older and frail patients. However, even if most decisions regarding the use of targeted agents in older patients with gastrointestinal cancer remain guided by subanalyses of large trials, data from recent older adult-specific trials are beginning to emerge, particularly in colorectal cancer. This review aims to summarize the existing evidence on treatment of older patients with gastrointestinal carcinomas (colon and rectum, stomach, esophagus, liver, and pancreas) with targeted agents (cetuximab, panitumumab, bevacizumab, ramucirumab, aflibercept, regorafenib, encorafenib, trastuzumab, sorafenib, lenvatinib, cabozantinib, erlotinib, olaparib), and place the evidence in a geriatric oncology perspective.
Collapse
Affiliation(s)
- Ana Raquel Monteiro
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Department of Medical Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal.
| | - Rita Saúde Conde
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Department of Medical Oncology, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal.
| | - Raquel Basto
- Instituto Português de Oncologia de Coimbra Francisco Gentil, Department of Medical Oncology, Av. Bissaya Barreto 98, 3000-075 Coimbra, Portugal.
| | - Francesco Sclafani
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
| | - Amélie Deleporte
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
| | - Alain Hendlisz
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
| | - Lissandra Dal Lago
- Institut Jules Bordet, Department of Medicine, Blvd de Waterloo 121, 1000 Brussels, Belgium.
| |
Collapse
|
4
|
Grechukhina KS, Chebotareva NV, Zhukova LG, Krasnova TN. Clinical and laboratory signs and risk factors for nephrotoxicity, associated with antiangiogenic drugs. TERAPEVT ARKH 2021; 93:661-666. [DOI: 10.26442/00403660.2021.06.200879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
Background. Anti-angiogenic anticancer drugs that block the vascular endothelial growth factor signaling pathway can cause renal damage. Assessment of the risk of nephrotoxicity allows developing optimal treatment approaches and ensuring the relative safety of therapy.
Aim. To assess early clinical and laboratory manifestations and risk factors for nephrotoxicity of antiangiogenic drugs.
Materials and methods. The study included 50 patients who received antiangiogenic drugs in different regimens of chemotherapy. Demographic factors, body mass index, blood pressure levels, type of antiangiogenic drug, and concomitant therapy were assessed. Before treatment and over a period of 8 weeks, the levels of hemoglobin, number of platelets and schistocytes, D-dimer levels, serum lactate dehydrogenase (LDH) levels, as well as daily proteinuria and serum creatinine and eGFRCKD-EPI were assessed. Linear regression analysis was performed to assess risk factors for nephrotoxicity and arterial hypertension (AH).
Results. The median age of patients was 46 [3457] years, 22 (44%) men and 28 (56%) women. AH developed in 52%, a decrease in eGFR in 42%, along with a decrease in hemoglobin levels and an increase in LDH levels at 2 weeks of therapy. The numbers of schistocytes and platelets significantly decreased by 8 weeks of therapy. Risk factors for impaired renal function during treatment with antiangiogenic drugs were an initial decrease in GFR less than 80 ml/min/1.73 m2, an increase in D-dimer levels, and a decrease in hemoglobin levels by 8 weeks of treatment. The risk factors for AH during therapy were the initial decrease in eGFR less than 80 ml/min/1.73 m2 and no prophylactic anticoagulant therapy.
Conclusion. Early signs of nephrotoxicity of antiangiogenic anticancer drugs were a decrease in eGFR and AH. The independent risk factors for nephrotoxicity were the initial decrease in eGFR, an increase in D-dimer levels, and a decrease in hemoglobin levels at 8 weeks of treatment, while the prophylactic use of anticoagulant therapy reduced this risk in our study.
Collapse
|
5
|
Brunello A, Galiano A, Finotto S, Monfardini S, Colloca G, Balducci L, Zagonel V. Older cancer patients and COVID-19 outbreak: Practical considerations and recommendations. Cancer Med 2020; 9:9193-9204. [PMID: 33219746 PMCID: PMC7774711 DOI: 10.1002/cam4.3517] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Since the COVID-19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high-quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early-stage and advanced-stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated.
Collapse
Affiliation(s)
- Antonella Brunello
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Antonella Galiano
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Silvia Finotto
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | | | - Giuseppe Colloca
- Dipartimento di Diagnostica per ImmaginiRadioterapia Oncologica ed EmatologiaIstituto di RadiologiaFondazione Policlinico A. Gemelli IRCCS ‐ Università Cattolica Sacro CuoreRomaItaly
| | - Lodovico Balducci
- Moffitt Cancer CenterUniversity of South Florida College of MedicineTampaFloridaUSA
| | - Vittorina Zagonel
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| |
Collapse
|
6
|
Clifton K, Luo J, Tao Y, Saam J, Rich T, Roshal A, Frith A, Rigden C, Ademuyiwa F, Weilbaecher K, Hernandez-Aya L, Peterson LL, Bagegni N, Suresh R, Bose R, Opyrchal M, Wildes TM, Ma C. Mutation profile differences in younger and older patients with advanced breast cancer using circulating tumor DNA (ctDNA). Breast Cancer Res Treat 2020; 185:639-646. [PMID: 33219484 DOI: 10.1007/s10549-020-06019-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Little is known regarding the mutation profiles of ctDNA in the older adult breast cancer population. The objective of this study is to assess differences in mutation profiles in the older adult breast cancer population using a ctDNA assay as well as assess utilization of testing results. METHODS Patients with advanced breast cancer underwent molecular profiling using a plasma-based ctDNA NGS assay (Guardant360) between 5/2015 and 10/2019 at Siteman Cancer Center. The profiling results of a multi-institutional database of patients with advanced breast cancer who had undergone molecular profiling were obtained. Associations between mutations and age group (≥ 65 vs. < 65) were examined using a Fisher's exact test. RESULTS In the single-institutional cohort, 148 patients (69.2%) were < 65 years old and 66 patients (30.8%) ≥ 65 years old. ATM, BRAF, and PIK3CA mutations were found more frequently in older patients with ER + HER2- breast cancers (p < 0.01). In the multi-institutional cohort, 5367 (61.1%) were < 65 years old and 3417 (38.9%) ≥ 65 years old. ATM, PIK3CA, and TP53 mutations were more common in the older cohort (p < 0.0001) and MYC and GATA3 mutations were less common in the older cohort (p < 0.0001). CtDNA testing influenced next-line treatment management in 40 (19.8%) patients in the single-institutional cohort. CONCLUSION When controlling for subtype, results from a single institution were similar to the multi-institutional cohort showing that ATM and PIK3CA were more common in older adults. These data suggest there may be additional molecular differences in older adults with advanced breast cancers.
Collapse
Affiliation(s)
- Katherine Clifton
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA.
| | - Jingqin Luo
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Yu Tao
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | | | | | - Anna Roshal
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Ashley Frith
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Caron Rigden
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Foluso Ademuyiwa
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Katherine Weilbaecher
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Leonel Hernandez-Aya
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Lindsay L Peterson
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Nusayba Bagegni
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Rama Suresh
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Ron Bose
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Mateusz Opyrchal
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Tanya M Wildes
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| | - Cynthia Ma
- Washington University, 660 South Euclid Avenue, Campus Box 8056, Saint Louis, MO, 63110, USA
| |
Collapse
|
7
|
Comprehensive geriatric assessment is an independent prognostic factor in older patients with metastatic renal cell cancer treated with first-line Sunitinib or Pazopanib: a single center experience. J Geriatr Oncol 2020; 12:290-297. [PMID: 32972885 DOI: 10.1016/j.jgo.2020.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/09/2020] [Accepted: 09/02/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is poor data on the prognostic role of Comprehensive Geriatric Assessment (CGA) in older patients with metastatic renal cell carcinoma (mRCC) treated with first line Tyrosine Kinase Inhibitors (TKIs). MATERIALS AND METHODS We retrospectively reviewed the clinical charts of mRCC patients older than 70 years treated at our Institute with first-line Sunitinib or Pazopanib for at least 6 months. Every patient received a CGA at baseline and was identified as fit, vulnerable or frail according to Balducci's Criteria. We then assessed the impact of CGA category on survival, disease control and tolerability of TKIs. RESULTS We identified 86 eligible patients. Median age: 74.5 years, 56% males; 45.4% were fit, 37.2% vulnerable and 17.4% frail at CGA. There were no significant differences in the rate of Grade (G)1-2 and G3-4 toxicities, dose reduction rates, PFS and OS between Sunitinib and Pazopanib. Fit, vulnerable and frail patients achieved significantly different median PFS (18.9 vs 11.2 vs 5.1 months; p < 0.001) and OS (35.5 vs 14.6 vs 10.9 months; p < 0.001). Patients categorized as fit had higher chance of receiving a second-line treatment (66.6% vs 28.9% in vulnerable/frail; p = 0.002). The incidence of G3/4 events was significantly lower in the fit subgroup (19% vs 45% in vulnerable/frail; p = 0.0025). CONCLUSIONS In our retrospective single-center experience, CGA could accurately discriminate patients with higher risk of experiencing G3/4 toxicities, shorter PFS, and lower chance of receiving a second line treatment. CGA strongly impacted on OS, independently from International mRCC Database Consortium (IMDC) classification.
Collapse
|
8
|
Nguyen NP, Vinh-Hung V, Baumert BG, Zamagni A, Arenas M, Motta M, Lara PC, Myint AS, Bonet M, Popescu T, Vuong T, Appalanaido GK, Trigo L, Karlsson U, Thariat J. Older Cancer Patients during the COVID-19 Epidemic: Practice Proposal of the International Geriatric Radiotherapy Group. Cancers (Basel) 2020; 12:E1287. [PMID: 32438703 PMCID: PMC7281232 DOI: 10.3390/cancers12051287] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022] Open
Abstract
The coronavirus disease 19 (COVID-19) pandemic is unprecedented as it reached all countries in the world within a record short period of time. Even though COVID-19 infection may be just severe in any adults, older adults (65-year-old or older) may experience a higher mortality rate. Among those affected, cancer patients may have a worse outcome compared to the general population because of their depressed immune status. As the health resources of most countries are limited, clinicians may face painful decisions about which patients to save if they require artificial ventilation. Cancer patients, especially the older ones, may be denied supportive care because of their shorter life expectancy. Thus, special considerations should be taken to prevent infection of older cancer patients and to provide them with adequate social support during their cancer treatment. The following proposal was reached: (1) Education of health care providers about the special needs of older cancer patients and their risks of infection. (2) Special consideration such as surgical masks and separate scheduling should be made to protect them from being infected. (3) Social services such as patient navigators should be provided to ensure adequate medical supply, food, and daily transportation to cancer centers. (4) Close monitoring through phone calls, telecommunication to ensure social distancing and psychological support from patient family to prevent anxiety and depression. (5) Shorter course of radiotherapy by use of hypofractionation where possible to decrease the needs for daily transportation and exposure to infection. (6) Enrollment of older cancer patients in clinical trials for potential antiviral medications if infection does occur. (7) Home health care telemedicine may be an effective strategy for older cancer patients with COVID-19 infection to avoid hospital admission when health care resources become restricted. (8) For selected patients, immunotherapy and targeted therapy may become the systemic therapy of choice for older cancer patients and need to be tested in clinical trials.
Collapse
Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20060, USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University Hospital of Martinique, 97200 Fort-de-France, France;
| | - Brigitta G. Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, 7000 Chur, Switzerland;
| | - Alice Zamagni
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy;
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University, University Rovira I Virgili, 43201 Tarragona, Spain;
| | - Micaela Motta
- Department of Radiation Oncology, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Pedro Carlos Lara
- Department of Radiation Oncology, Fernando Pessoa Canarias Las Palmas University, 35001 Las Palmas, Spain;
| | - Arthur Sun Myint
- Department of Radiation Oncology, Clatterbridge Cancer Center, Liverpool CH63 4JY, UK;
| | - Marta Bonet
- Department of Radiation Oncology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain;
| | - Tiberiu Popescu
- Department of Radiation Oncology, Prof. Dr. Ion Chricuta Oncology Institute, 400015 Cluj-Napoca, Romania;
| | - Te Vuong
- Department of Radiation Oncology, McGill University, Jewish General Hospital, Montreal, QC H3T1E2, Canada;
| | | | - Lurdes Trigo
- Department of Radiation Oncology, Instituto Portugues de Oncologia do Porto Francisco Martins Porto E.P.E, 4200-072 Porto, Portugal;
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Group, Washington, DC 20001, USA;
| | - Juliette Thariat
- Department of Radiation Oncology, Baclesse Cancer Center, 14000 Caen, France;
| |
Collapse
|
9
|
Dagher M, Sabidó M, Zöllner Y. Effect of age on the effectiveness of the first-line standard of care treatment in patients with metastatic colorectal cancer: systematic review of observational studies. J Cancer Res Clin Oncol 2019; 145:2105-2114. [PMID: 31201484 PMCID: PMC6658416 DOI: 10.1007/s00432-019-02948-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/29/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Most metastatic colorectal cancer (mCRC) patients are elderly. This systematic review identifies and describes observational studies evaluating the influence of age on first-line treatment effectiveness in real-world practice. METHODS Medline and EMBASE were searched up to May 2016. The included studies were those that investigated first-line treatment of mCRC and reported age groups and overall survival (OS), progression-free survival (PFS) or overall response rate (ORR) were included. Studies published before 2008 were excluded. Study quality was assessed using the Newcastle-Ottawa Scale. Data were evaluated by age group (< 70 vs. ≥ 70 years; 65-75 vs. ≥ 75 years) and outcome. A pooled survival median was calculated for patients (cutoff = 70 years). RESULTS In total, 11 articles with 11,063 patients were included. Four studies using a cutoff of 70 years of age reported OS and PFS, and two studies reported ORRs. In terms of OS, all studies showed a higher OS for those < 70 years of age than for those ≥ 70 years of age. PFS did not find differences by age. For ORRs, one study favoured the younger group, while the second study did not differ by age. Based on three studies, the pooled medians for < 70 years of age and ≥ 70 years of age were the same for PFS (10.2) and were 27.0 and 22.9 for OS, respectively. All included studies were of high or acceptable quality. CONCLUSIONS The results suggest that age has no effect on PFS. For ORR, the results were inconsistent between studies. Younger patients in general had better OS, which might be partly explained by more aggressive treatment. This treatment seemed not to be guided by performance status or number of metastatic sites.
Collapse
Affiliation(s)
- Mohammed Dagher
- Hamburg University of Applied Sciences, 21033 Hamburg, Germany
| | - Meritxell Sabidó
- Global Epidemiology Department, Merck KGaA, Frankfurter Str. 250, 64293 Darmstadt, Germany
| | - York Zöllner
- Hamburg University of Applied Sciences, 21033 Hamburg, Germany
| |
Collapse
|
10
|
Efficacy of chemotherapy for older patients with gastric cancer: a multicenter retrospective cohort study. Int J Clin Oncol 2019; 24:1377-1384. [PMID: 31346818 DOI: 10.1007/s10147-019-01501-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gastric cancer is one of the leading causes of malignant disease-related mortality, worldwide. With the use of recently developed anti-tumor agents, the prognoses of patients with unresectable gastric cancer are improving. However, the development of an aggressive treatment strategy for older patients (OPs) remains under debate due to concerns regarding treatment feasibility or patient frailty. We aimed to elucidate whether aggressive chemotherapy has survival benefits for OPs with advanced gastric cancer. METHODS We analyzed consecutive patients diagnosed with inoperable advanced gastric cancer across seven hospitals from August 2007 to July 2015. We defined OPs as patients aged 75 years or older and compared their survival rates with those of non-older patients (NPs). RESULTS A total of 256 OPs and 425 NPs were enrolled. Of the OPs, 152 patients received chemotherapy and 104 patients received best supportive care (BSC). In contrast, among the NPs, 375 patients received chemotherapy and 50 patients received BSC. There was no significant difference of the median survival time between OPs and NPs in the response to BSC (61 vs 43 days) or chemotherapy (312 vs 348 days). Combination chemotherapy significantly improved survival compared to monotherapy in both OPs and NPs groups (382 vs 253 days in OPs, 381 vs 209 days in NPs). Good performance status, combination therapy, and male, but not age, were significant independent prognostic factors. CONCLUSION When the performance status of a gastric cancer patient is good, active chemotherapy may improve survival, regardless of age.
Collapse
|
11
|
Feliu J, Heredia-Soto V, Gironés R, Jiménez-Munarriz B, Saldaña J, Guillén-Ponce C, Molina-Garrido MJ. Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients. Clin Transl Oncol 2019; 22:457-467. [PMID: 31240462 DOI: 10.1007/s12094-019-02167-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/16/2019] [Indexed: 12/22/2022]
Abstract
The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, so cancer treatment in the older patient remains a therapeutic challenge. The physiological changes associated with aging increase the risk of developing a serious toxicity induced by chemotherapy treatment, as well as other undesirable consequences as hospitalizations, dependence and non-compliance with treatment, that can negatively affect survival, quality of life and treatment efficacy. The use of hematopoietic growth factors and other active supportive interventions in the elderly can help prevent and/or alleviate these toxicities. However, we have little data on the efficacy and tolerance of support treatments in the older patient. The objective of this work is to review the most frequent toxicities of oncological treatments in the elderly and their management.
Collapse
Affiliation(s)
- J Feliu
- Medical Oncology Department, H. Universitario La Paz, CIBERONC, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - V Heredia-Soto
- Medical Oncology Department, H. Universitario La Paz, CIBERONC, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - R Gironés
- Medical Oncology Department, H. Lluís Alcanyís. Xàtiva, Valencia, Spain
| | - B Jiménez-Munarriz
- Medical Oncology Department, H. Universitario Clara Campal, Madrid, Spain
| | - J Saldaña
- Medical Oncology Department, Instituto Catalán de Oncología, Hospitalet, Barcelona, Spain
| | - C Guillén-Ponce
- Medical Oncology Department, H. Universitario Ramón Y Cajal, Madrid, Spain
| | | |
Collapse
|
12
|
Clapes V, Rousseau V, Despas F, Montastruc JL, Olivier P. Adverse Drug Reactions Involving Protein Kinase Inhibitors: A French Pharmacovigilance Database Study Comparing Safety in Younger and Older Patients (≥ 75 years) with Cancer. Pharmaceut Med 2019; 33:21-27. [DOI: 10.1007/s40290-018-0259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Lund CM, Vistisen KK, Dehlendorff C, Rønholt F, Johansen JS, Nielsen DL. Age-dependent differences in first-line chemotherapy in patients with metastatic colorectal cancer: the DISCO study. Acta Oncol 2018; 57:1445-1454. [PMID: 30375911 DOI: 10.1080/0284186x.2018.1531299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES First-line chemotherapy for metastatic colorectal cancer (mCRC) is effective and feasible in selected older patients. We investigated age-dependent differences in treatment and outcomes in patients with mCRC in clinical practice. MATERIAL AND METHODS A retrospective study of 654 patients with mCRC referred to first-line chemotherapy in 2008-2014. Patients were divided into two age groups: 50-69 and ≥70 (older patients). Binary outcomes were analyzed by logistic regression. Progression-free survival (PFS) and overall survival (OS) were analyzed by Cox proportional hazards regression, CRC-specific and other-cause mortality with Fine and Gray proportional hazard model for the sub-distribution of a competing risk. RESULTS After adjusting for performance status (PS) and comorbidity, older patients were more likely to receive monotherapy (adjusted odds ratio (aOR) = 9.00, 95% confidence interval (CI) 4.52-17.91), lower doses, and no additional targeted therapy (aOR = 1.89, 95% CI 1.28-2.78) than younger patients. Yet, older patients experienced more toxicity and hospitalizations (aOR = 1.53, 95% CI 1.08-2.17). Among those treated, older patients had shorter PFS (hazard ratio (HR) = 1.32, 95% CI 1.11-1.57), but after adjusting for PS and comorbidity, PFS was similar. No significant difference was found in CRC mortality (HR = 1.15, 95% CI 0.95-1.40) between age groups. Poor PS was associated with shorter OS and PFS and higher CRC mortality. CONCLUSIONS In the DISCO study, older patients with mCRC received less aggressive first-line chemotherapy. Yet, they experienced more toxicity. Younger and older patients had similar CRC mortality. Shorter PFS and higher CRC mortality were observed in patients with poor PS.
Collapse
Affiliation(s)
- Cecilia M. Lund
- Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Kirsten K. Vistisen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Christian Dehlendorff
- Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Finn Rønholt
- Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Julia S. Johansen
- Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Dorte L. Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
14
|
Shen S, Li Y, Xiao Y, Zhao Z, Zhang C, Wang J, Li H, Liu F, He N, Yuan Y, Lu Y, Guo S, Wang Y, Liao W, Liao Y, Chen Y, Bin J. Folate-conjugated nanobubbles selectively target and kill cancer cells via ultrasound-triggered intracellular explosion. Biomaterials 2018; 181:293-306. [PMID: 30096563 DOI: 10.1016/j.biomaterials.2018.07.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 01/01/2023]
Abstract
With the rapid development of cancer-targeted nanotechnology, a variety of nanoparticle-based drug delivery systems have clinically been employed in cancer therapy. However, multidrug resistance significantly impacts the therapeutic efficacy. Physical non-drug therapy has emerged as a new and promising strategy. This study aimed to determine whether novel folate-nanobubbles (F-NBs), combined with therapeutic ultrasound (US), could act as a safe and effective physical targeted cancer therapy. Using folate-conjugated N-palmitoyl chitosan (F-PLCS), we developed novel F-NBs and characterised their physicochemical properties, internalization mechanism, targeting ability, therapeutic effects, and killing mechanism. The results showed that the novel F-NBs selectively accumulated in FR-positive endothelial cells and tumour cells via FR coupled with clathrin- and caveolin-mediated endocytosis in vitro and in vivo. In addition, the F-NBs killed target cells by an intracellular explosion under US irradiation. Hoechst/PI staining demonstrated that apoptosis and necrosis accounted for a large proportion of cell death in vivo. F-NBs combined with US therapy significantly inhibited tumour growth and improved the overall survival of tumour-bearing mice. Under US irradiation, the novel F-NBs selectively killed FR-positive tumour cells in vitro and in vivo via intracellular explosion and therefore is a promising alternative for targeted cancer treatment.
Collapse
Affiliation(s)
- Shuxin Shen
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China; Department of Cardiology, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Ying Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China; Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Yunbin Xiao
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zonglei Zhao
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chuanxi Zhang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Junfen Wang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hairui Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Feng Liu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Nvqin He
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ye Yuan
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yongkang Lu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Shengcun Guo
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yan Wang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yulin Liao
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yanmei Chen
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Jianping Bin
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
15
|
Prior JO, Gillessen S, Wirth M, Dale W, Aapro M, Oyen WJ. Radiopharmaceuticals in the elderly cancer patient: Practical considerations, with a focus on prostate cancer therapy. Eur J Cancer 2017; 77:127-139. [DOI: 10.1016/j.ejca.2017.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/12/2017] [Accepted: 01/29/2017] [Indexed: 11/24/2022]
|
16
|
Pan-Cancer Analysis of Genomic Sequencing Among the Elderly. Int J Radiat Oncol Biol Phys 2017; 98:726-732. [PMID: 28258894 DOI: 10.1016/j.ijrobp.2017.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/19/2016] [Accepted: 01/01/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE We hypothesized that elderly patients might have age-specific genetic abnormalities yet be underrepresented in currently available sequencing repositories, which could limit the effect of sequencing efforts for this population. METHODS AND MATERIALS Leveraging The Cancer Genome Atlas (TCGA) data portal, 9 tumor types were analyzed. The frequency distribution of cancer by age was determined and compared with Surveillance, Epidemiology, and End Results data. Using the estimated median somatic mutational frequency of each tumor type, the samples needed beyond TCGA to detect a 10% mutational frequency were calculated. Microarray data from a separate prospective cohort were obtained from primary prostatectomy samples to determine whether elderly-specific transcriptomic alterations could be identified. RESULTS Of the 5236 TCGA samples, 73% were from patients aged <70 years. Comparing the distribution of TCGA samples by age to the Surveillance, Epidemiology, and End Results data, patients <70 years were well represented across most tumor types, but patients aged 80 to 99 years were underrepresented in all cancers (median TCGA underrepresentation of 167%). All cancers (except for colorectal) contained enough samples to detect a 10% mutational frequency in patients aged <60 years. In contrast, no cancer type had enough samples for which a 10% mutational frequency could be detected in patients aged ≥80 years. To further interrogate whether elderly patients with cancer were likely to harbor age-specific molecular abnormalities, we accessed transcriptomic data from a separate, larger database of >2000 prostate cancer samples. That analysis revealed significant differences in the expression of 10 genes in patients aged ≥70 years compared with those <70 years, of which 7 are involved in androgen signaling and/or DNA repair. CONCLUSIONS Elderly patients have been underrepresented in genomic sequencing studies. Our data suggest the presence of elderly-specific molecular alterations. Further dedicated efforts to understand the biology of cancer among the elderly will be important moving forward.
Collapse
|
17
|
Serkova NJ, Eckhardt SG. Metabolic Imaging to Assess Treatment Response to Cytotoxic and Cytostatic Agents. Front Oncol 2016; 6:152. [PMID: 27471678 PMCID: PMC4946377 DOI: 10.3389/fonc.2016.00152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/07/2016] [Indexed: 12/24/2022] Open
Abstract
For several decades, cytotoxic chemotherapeutic agents were considered the basis of anticancer treatment for patients with metastatic tumors. A decrease in tumor burden, assessed by volumetric computed tomography and magnetic resonance imaging, according to the response evaluation criteria in solid tumors (RECIST), was considered as a radiological response to cytotoxic chemotherapies. In addition to RECIST-based dimensional measurements, a metabolic response to cytotoxic drugs can be assessed by positron emission tomography (PET) using (18)F-fluoro-thymidine (FLT) as a radioactive tracer for drug-disrupted DNA synthesis. The decreased (18)FLT-PET uptake is often seen concurrently with increased apparent diffusion coefficients by diffusion-weighted imaging due to chemotherapy-induced changes in tumor cellularity. Recently, the discovery of molecular origins of tumorogenesis led to the introduction of novel signal transduction inhibitors (STIs). STIs are targeted cytostatic agents; their effect is based on a specific biological inhibition with no immediate cell death. As such, tumor size is not anymore a sensitive end point for a treatment response to STIs; novel physiological imaging end points are desirable. For receptor tyrosine kinase inhibitors as well as modulators of the downstream signaling pathways, an almost immediate inhibition in glycolytic activity (the Warburg effect) and phospholipid turnover (the Kennedy pathway) has been seen by metabolic imaging in the first 24 h of treatment. The quantitative imaging end points by magnetic resonance spectroscopy and metabolic PET (including 18F-fluoro-deoxy-glucose, FDG, and total choline) provide an early treatment response to targeted STIs, before a reduction in tumor burden can be seen.
Collapse
Affiliation(s)
- Natalie J. Serkova
- Department of Anesthesiology, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
- Developmental Therapeutics Program, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - S. Gail Eckhardt
- Developmental Therapeutics Program, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
- Division of Medical Oncology, Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
| |
Collapse
|
18
|
Update on the Use and Treatment of Targeted Molecular Inhibitors for Locally Advanced and Metastatic Non-Melanoma Skin Cancers. Dermatol Surg 2016; 42 Suppl 1:S49-56. [PMID: 26730974 DOI: 10.1097/dss.0000000000000573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Targeting specific molecular pathway inhibitors has provided a successful approach to the management of selected patients with advanced non-melanoma skin cancer (NMSC). Clinical trials and case studies have provided a rationale for their use in clinical settings. OBJECTIVE To review the current approaches to the use of targeted molecular inhibitors for locally advanced and metastatic squamous cell carcinoma, basal cell carcinoma, and dermatofibrosarcoma protuberans. METHODS Literature review of the current use of molecular inhibitors in the treatment of NMSCs, including case studies, reports, and clinical trials. CONCLUSION The development of molecular pathway inhibitors for the treatment of advanced and metastatic NMSC has increased survival rates and improved clinical outcomes in selected patients with advanced disease.
Collapse
|
19
|
Bretagne M, Boudou-Rouquette P, Huillard O, Thomas-Schoemann A, Chahwakilian A, Orvoen G, Arrondeau J, Tlemsani C, Cessot A, Cabanes L, Blanchet B, Coriat R, Alexandre J, Goldwasser F. [Tyrosine kinase inhibiting the VEGF pathway and elderly people: Tolerance, pre-treatment assessment and side effects management]. Bull Cancer 2016; 103:259-72. [PMID: 26832420 DOI: 10.1016/j.bulcan.2015.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
Angiogenesis inhibition is a major antitumor strategy that has emerged during the last decade. Oral tyrosine kinase inhibitors (TKI) targeting the VEGF receptor, including sunitinib, sorafenib, axitinib, regorafenib, pazopanib, and vandetanib reduce tumor growth and metastasis. These agents are approved for the treatment of metastatic diseases in first or second-line. They display a narrow therapeutic index. However, data in the elderly and/or in patients with multiple illnesses remain scarce. This population is classically excluded from clinical trials. The aim of this review is to provide an overview of existing literature regarding antiangiogenic TKI tolerance in the elderly (>70 years old). We also highlight key points of the pre-therapeutic evaluation and summarize the management of common toxicities.
Collapse
Affiliation(s)
- Marie Bretagne
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Pascaline Boudou-Rouquette
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France.
| | - Olivier Huillard
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Audrey Thomas-Schoemann
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, laboratoire de pharmacologie et toxicologie, Paris, France
| | - Anne Chahwakilian
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de gériatrie, Paris, France
| | - Galdric Orvoen
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de gériatrie, Paris, France
| | - Jennifer Arrondeau
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Camille Tlemsani
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Anatole Cessot
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Laure Cabanes
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de cardiologie, Paris, France
| | - Benoit Blanchet
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, laboratoire de pharmacologie et toxicologie, Paris, France
| | - Romain Coriat
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de gastro-entérologie, Paris, France
| | - Jérôme Alexandre
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - François Goldwasser
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| |
Collapse
|
20
|
Singh JC, Lichtman SM. Effect of age on drug metabolism in women with breast cancer. Expert Opin Drug Metab Toxicol 2016; 11:757-66. [PMID: 25940027 DOI: 10.1517/17425255.2015.1037277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aging of the population will increase the number of breast cancer patients requiring treatment in both the adjuvant and metastatic setting. Hormones, chemotherapy and targeted drugs all have a role in treatment. Older patients have been underrepresented in clinical trials making evidence-based decisions difficult. The increase in comorbidity and aging, polypharmacy and changes in function make pharmacotherapy decisions more complicated. Knowledge of the issues is critical in the prescribing of effective and safe therapy. There are factors associated with advancing age that can result in pharmacokinetic and pharmacodynamic variations in processing of hormonal agents, chemotherapy and targeted drugs. AREAS COVERED A review of the literature pertaining to pharmacokinetic changes in aging in breast cancer was untaken. Studies are reviewed involving single agents and some combinations. EXPERT OPINION Older patients should be considered for standard therapies. Their specific problems need to be evaluated by geriatric-specific assessment including functional status, end organ dysfunction and polypharmacy. There are few instances for age-related changes in pharmacokinetics and when present are usually not clinically significant. When changes are present, they are often the result of comorbidity, drug interactions and drug scheduling issues. The older patients may be more sensitive to certain toxicities such as cardiac toxicity, neuropathy and myelosuppression.
Collapse
Affiliation(s)
- Jasmeet C Singh
- Memorial Sloan Kettering Cancer Center , 650 Commack Road, Commack, NY 11725 , USA +1 631 623 4100 ; +1 631 864 3827 ;
| | | |
Collapse
|
21
|
Carver JR. Cardiac toxicity in the elderly and the role of cardio oncology. PROGRESS IN PEDIATRIC CARDIOLOGY 2015. [DOI: 10.1016/j.ppedcard.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
22
|
Abstract
With earlier cancer diagnosis among older patients with cancer, the possibility of curing cancer increases. However, cancer treatment may have a long-lasting impact on older cancer survivors. It is vital to screen, diagnose, and properly manage the long-term toxicities of cancer treatment in order to maintain the quality of life of older cancer survivors.
Collapse
|
23
|
Personalised medicine in veterinary oncology: One to cure just one. Vet J 2015; 205:128-35. [DOI: 10.1016/j.tvjl.2015.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 01/04/2015] [Accepted: 01/05/2015] [Indexed: 12/14/2022]
|
24
|
Balducci L. Should We Preclude Phase 1 Clinical Trials From Enrolling Elderly Individuals? Cancer Control 2015; 22:232-4. [PMID: 26068770 DOI: 10.1177/107327481502200216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
25
|
Arceci RJ. Dendritic Cell Disorders: Matters of Lineage and Clinical Drug Testing in Rare Diseases. J Clin Oncol 2015; 33:383-5. [DOI: 10.1200/jco.2014.58.9804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Robert J. Arceci
- Children's Center for Cancer and Blood Disorders, Ron Matricaria Institute of Molecular Medicine at Phoenix Children's Hospital, University of Arizona, College of Medicine, Phoenix, AZ
| |
Collapse
|