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Lyu N, Yi JZ, Zhao M. Immunotherapy in older patients with hepatocellular carcinoma. Eur J Cancer 2021; 162:76-98. [PMID: 34954439 DOI: 10.1016/j.ejca.2021.11.024] [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: 08/01/2021] [Revised: 10/31/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common types of cancer globally and is currently the third leading cause of cancer-related deaths. Recently, immunotherapy using immune checkpoint inhibitors (ICIs) has been shown with encouraging anticancer activity and safety in clinical trials. To reverse the phenomenon of tumours evading immune response, ICIs can be used to stimulate the natural antitumour potential of cancer cells by blocking the relevant checkpoints to activate T cells. However, the components and functions of the immune system may undergo a series of changes with ageing, known as 'immunosenescence,' potentially affecting the antitumour effect and safety of immunotherapy. In the current phase III clinical trials of ICIs including nivolumab, pembrolizumab and atezolizumab, the proportion of patients with HCC older than 65 years in CheckMate 459, KEYNOTE-240 and IMbrave150 is 51%, 58% and 50%, respectively, which is less than 70%-73% of epidemiological investigation. Therefore, the elderly population recruited in clinical trials may not accurately represent the real-world elderly patients with HCC, which affects the extrapolation of the efficacy and safety profile obtained in clinical trials to the elderly population in the real world. This review provides the latest advances in ICIs immuno-treatment available for HCC and relevant information about their therapeutic effects and safety on elderly patients. We discuss the benefits of ICIs for older HCC patients, and relevant recommendations about conducting further clinical trials are proposed for more complete answers to this clinical issue.
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Affiliation(s)
- Ning Lyu
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun-Zhe Yi
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Ming Zhao
- Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Factors affecting the decision to investigate older adults with potential cancer symptoms: a systematic review. Br J Gen Pract 2021; 72:e1-e10. [PMID: 34782315 PMCID: PMC8597772 DOI: 10.3399/bjgp.2021.0257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Older age and frailty increase the risk of morbidity and mortality from cancer surgery and intolerance of chemotherapy and radiotherapy. The effect of old age on diagnostic intervals is unknown; however, older adults need a balanced approach to the diagnosis and management of cancer symptoms, considering the benefits of early diagnosis, patient preferences, and the likely prognosis of a cancer. AIM To examine the association between older age and diagnostic processes for cancer, and the specific factors that affect diagnosis. DESIGN AND SETTING A systematic literature review. METHOD Electronic databases were searched for studies of patients aged >65 years presenting with cancer symptoms to primary care considering diagnostic decisions. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-analysis guidelines. RESULTS Data from 54 studies with 230 729 participants were included. The majority of studies suggested an association between increasing age and prolonged diagnostic interval or deferral of a decision to investigate cancer symptoms. Thematic synthesis highlighted three important factors that resulted in uncertainty in decisions involving older adults: presence of frailty, comorbidities, and cognitive impairment. Data suggested patients wished to be involved in decision making, but the presence of cognitive impairment and the need for additional time within a consultation were significant barriers. CONCLUSION This systematic review has highlighted uncertainty in the management of older adults with cancer symptoms. Patients and their family wished to be involved in these decisions. Given the uncertainty regarding optimum management of this group of patients, a shared decision-making approach is important.
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Arias Ron D, Areses Manrique MC, Mosquera Martínez J, García González J, Afonso Afonso FJ, Lázaro Quintela M, Fernández Núñez N, Azpitarte Raposeiras C, Amenedo Gancedo M, Santomé Couto L, García Campelo MR, Muñoz Iglesias J, Ruiz Bañobre J, Vilchez Simo R, Casal Rubio J, Campos Balea B, Carou Frieiro I, Alonso-Jaudenes Curbera G, Anido Herranz U, García Mata J, Fírvida Pérez JL. Efficacy and safety of Nivolumab in older patients with pretreated lung cancer: A subgroup analysis of the Galician lung cancer group. J Geriatr Oncol 2020; 12:410-415. [PMID: 33357975 DOI: 10.1016/j.jgo.2020.11.010] [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: 07/24/2020] [Revised: 10/14/2020] [Accepted: 11/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nivolumab is an anti PD1 immunotherapy drug approved for advanced Non-Small Cell Lung Cancer (NSCLC) patients who previously received at least one prior line of treatment. Older patients are often not represented in clinical trials and drugs with acceptable safety profiles are necessary. We aim to report the efficacy and safety profile of Nivolumab in the real-world older subgroup of the Galician lung cancer group study. PATIENTS AND METHODS We retrospectively reviewed 188 advanced NSCLC patients treated with at least one prior therapy. We collected data from patients who were ≥70 years old treated with Nivolumab in second or subsequent lines. Patient characteristics, treatment efficacy (overall survival, progression-free survival, and response rate), and safety profile were reported. RESULTS Thirty-eight patients aged ≥70 years were included in the subgroup analysis. The median age was 74.5 years, a high percentage of patients were males (95%), most had a Performance Status of 1 (79%) and only 13% were non-smokers. The predominant histology was adenocarcinoma (53%), and 18% of patients received 2 or more lines. The median Progression-Free Survival was 7.53 months (CI 4.3-17.3, p = 0.15) and the median Overall Survival was 14.85 months (CI 10.5-20.7, p = 0.44). The objective response rate was 42%. No new adverse events were reported in comparison to a global population. CONCLUSIONS The efficacy and safety profile of Nivolumab in advanced NSCLC patients treated with at least one prior therapy and age ≥70 years old can be overlapped to a global population. Further prospective trials are needed to define and confirm these results.
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Affiliation(s)
- David Arias Ron
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain.
| | | | | | - Jorge García González
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | | | | | | | | | | | | | | | - Jose Muñoz Iglesias
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Juan Ruiz Bañobre
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Rocío Vilchez Simo
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Begoña Campos Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Iria Carou Frieiro
- Medical Oncology Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | | | - Urbano Anido Herranz
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Jesús García Mata
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
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Pérez Rueda M, Herreros B, Guijarro C, Comeche B. Neoplasias diagnosticadas en planta de medicina interna: características y factores determinantes para limitar los esfuerzos diagnóstico-terapéuticos. Rev Clin Esp 2010; 210:592-3. [DOI: 10.1016/j.rce.2010.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 05/21/2010] [Indexed: 10/18/2022]
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Prescribers’ attitudes toward elderly breast cancer patients. Discrimination or empathy? Crit Rev Oncol Hematol 2010; 75:138-50. [DOI: 10.1016/j.critrevonc.2009.09.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 09/08/2009] [Accepted: 09/24/2009] [Indexed: 11/23/2022] Open
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Campos S, Presutti R, Zhang L, Salvo N, Hird A, Tsao M, Barnes EA, Danjoux C, Sahgal A, Mitera G, Sinclair E, DeAngelis C, Nguyen J, Napolskikh J, Chow E. Elderly patients with painful bone metastases should be offered palliative radiotherapy. Int J Radiat Oncol Biol Phys 2009; 76:1500-6. [PMID: 19540056 DOI: 10.1016/j.ijrobp.2009.03.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/11/2009] [Accepted: 03/17/2009] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the efficacy of palliative radiotherapy (RT) in relieving metastatic bone pain in elderly patients. METHODS AND MATERIALS The response to RT for palliation of metastatic bone pain was evaluated from a prospective database of 558 patients between 1999 and 2008. The pain scores and analgesic intake were used to calculate the response according to the International Bone Metastases Consensus Working Party palliative RT endpoints. Subgroup analyses for age and other demographic information were performed. RESULTS No significant difference was found in the response rate in patients aged >or=65, >or=70, and >or=75 years compared with younger patients at 1, 2, or 3 months after RT. The response was found to be significantly related to the performance status. CONCLUSION Age alone did not affect the response to palliative RT for bone metastases. Elderly patients should be referred for palliative RT for their painful bone metastases, regardless of age, because they receive equal benefit from the treatment.
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Affiliation(s)
- Sarah Campos
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Saunders C, Robotin M, Crossing S. By invitation only - the case for breast cancer screening reminders for women over 69 years. AUSTRALIA AND NEW ZEALAND HEALTH POLICY 2008; 5:23. [PMID: 18990199 PMCID: PMC2612671 DOI: 10.1186/1743-8462-5-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 11/06/2008] [Indexed: 12/05/2022]
Abstract
BACKGROUND Breast cancer is the leading cause of cancer death in women in Australia. Early detection provides the best chance of reducing mortality and morbidity from the disease. Mammographic screening is a population health strategy for the early detection of breast cancer in Australia. Recruitment strategies such as regular advertising and biannual screening invitations are exclusively targeted at women aged 50 - 69 years. Even though they can participate, women 70 years or over are not invited or actively encouraged to undertake screening. Research has found that a routine letter of invitation increases the number of women participating in breast cancer screening. METHODS Cancer data analysis and a literature and policy review was conducted to assess age specific breast cancer mortality rates and the legitimacy of rationale used to limit invitations for breast cancer screening to women younger than 70 years. RESULTS The proportion of women over 69 years participating in the BreastScreen program is significantly less than rate of screening in the target age range (50-69 years). Evidence and data indicate that common justifications for limiting screening reminders to the target age range including life expectancy, comorbidities, effectiveness, treatment and cost are, for many women, unreasonable. CONCLUSION There is now sufficient data to support a change in the targeted upper age range for breast cancer screening to improve the existing suboptimal surveillance in women aged over 69 years.
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Affiliation(s)
| | - Monica Robotin
- The Cancer Council NSW, Woolloomooloo NSW, Australia
- School of Public Health, University of Sydney, Australia
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Rose JH, O'Toole EE, Einstadter D, Love TE, Shenko CA, Dawson NV. Patient Age, Well-Being, Perspectives, and Care Practices in the Early Treatment Phase for Late-Stage Cancer. J Gerontol A Biol Sci Med Sci 2008; 63:960-8. [DOI: 10.1093/gerona/63.9.960] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khafif A, Posen J, Yagil Y, Beiser M, Gil Z, Ben-Yosef R, Landsberg R, Fliss DM. Quality of life in patients older than 75 years following major head and neck surgery. Head Neck 2007; 29:932-9. [PMID: 17615568 DOI: 10.1002/hed.20635] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study was designed to evaluate the quality of life (QOL) of patients older than 75 years undergoing major head and neck surgery. METHODS Three groups of patients were included: elderly patients (>75, n = 35) and younger patients (65 to 75 years, n = 30) undergoing major head and neck surgery and healthy controls (>75, n = 40). Measurements were made using the SF-12 health survey, the University of Washington QOL questionnaire, and measurements of the "sense of burden" on the caregiver. RESULTS With the SF-12, the role physical, role emotional, and bodily pain were decreased by the surgical intervention, while physical function was affected by age alone. With the UW-QOL Questionnaire, overall QOL was preserved. "Appearance" and "Leisure" subscales were affected by the surgical intervention and old age. "Chewing" and "Activity" were decreased by the surgical intervention in the older patients, and "Speech" was affected by the surgical intervention alone. The "sense of burden" was alleviated by surgery in the elderly patients. CONCLUSIONS Several QOL domains are decreased in elderly patients undergoing major head and neck surgery.
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Affiliation(s)
- Avi Khafif
- Department of Otolaryngology--Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Abstract
OBJECTIVES To review the available scientific literature on cancer care in nursing homes and recommendations for clinical practice and further research are offered. DATA SOURCES Research studies and review articles. CONCLUSION Overlooked issues for older adults with cancer in nursing homes include screening, treatment, and symptom management. Cancer care and survivorship in nursing homes receives little direct attention. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can improve cancer care and survivorship in nursing homes by considering nursing homes as a practice venue.
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Votron L, D'Hoore W, Swine C, Daisne JF, Scalliet P. The opinion of general practitioners on the treatment of prostate and breast cancer in elderly people: results of a survey based on clinical models. Clin Oncol (R Coll Radiol) 2004; 16:474-8. [PMID: 15490809 DOI: 10.1016/j.clon.2004.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Several publications have reported age-related differences in the management of people with cancer. Most data have been derived retrospectively from hospital or cancer-centre databases. The aim of the present study was to identify major decisional factors observed in general practitioner (GP) practices, outside the hospital setting, regarding the clinical management of patients with prostate and breast cancer. MATERIALS AND METHODS During three national GP meetings in Belgium, questionnaires presenting two simulated patient cases were presented to GPs who were asked two questions: one regarding further staging and referral of the case and the second regarding the treatment of the case. A total of 678 questionnaires were distributed. GPs received two randomly selected cases each: a breast cancer history and a prostate cancer history. Three variables were assessed simultaneously: age, performance status and medical history (comorbidity). RESULTS The analysis indicated that elderly patients were more likely to be referred for non-curative treatment (OR 13.71; 95% CI 5.67-33.12; P < 0.0001 for prostate cancer and OR 17.67; 95% CI 4.04-77.31; P < 0.0001 for breast cancer). The other variables (performance status and medical history) did not affect treatment orientation. However, GPs were prepared to seek assistance from oncologists in both cases, irrespective of the patient's age. CONCLUSION Age seems to be more important among GPs in deciding how to manage cancer patients than performance status and comorbidity. This is a very common prejudice. They are, nevertheless, inclined to refer people with cancer to oncologists independently of the patient's age.
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Affiliation(s)
- L Votron
- Department of Radiation Oncology, University Hospital St-Luc, Brussels, Belgium
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Abstract
INTRODUCTION Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Cancer in the elderly is therefore a public health issue at stake. However, in daily clinical practice the elderly presenting cancer are not listened to with great interest and treatment is often not proper or suboptimal. CURRENT KNOWLEDGE AND KEY POINTS Diagnosis in the elderly is established at a more advanced stage of cancer than in younger people; diagnostic workup is reduced and suboptimal treatments are implemented. Therefore, barriers exist that prevent the elderly from accessing the healthcare system as easily as their younger counterpart. Misconceptions about cancer also lead them to delay their first visit. As well, although treatment with curative intent and without major side-effect is feasible, physicians have misconceptions regarding therapeutic possibilities. Due to the heterogeneity of the so-called "ageing population", difficulties are related to patients' selection. FUTURE PROSPECTS AND PROJECTS Decision in oncology for the elderly must walk a fine line in attempting to deliver the best treatment under the best conditions. Age per se must not be the only criterion for medical decision. Providing accurate information adapted to the elderly, with large circulation among healthcare professionals, should lead to the same quality of care as that in young people. Comprehensive multimodal geriatric assessments should help to further differentiate patients who may benefit from curative treatment from those for whom only palliative treatment is necessary.
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Affiliation(s)
- T Pignon
- Service de radiothérapie oncologie, hôpital de la Timone, Marseille, France
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Affiliation(s)
- J J Grau
- University of Barcelona, Institut de Malalties Hemato-Oncologiques, Medical Oncology Department and Radiation Oncology Department, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain.
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