1
|
Antherieu G, Heiblig M, Freyer G, Ghesquieres H, Falandry C. Impact of Age on Poly(ADP-Ribose) Polymerase Inhibitor (PARPi)-Induced Lymphopenia: A Scoping Review of the Literature and Internal Analysis of a Retrospective Database. Drugs Aging 2023; 40:397-405. [PMID: 37081248 PMCID: PMC10118227 DOI: 10.1007/s40266-023-01023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Poly(ADP-ribose) polymerase inhibitors (PARPi) are increasingly used in oncology; their hematological toxicities affect classically red, platelet and neutrophil lineages, but some opportunistic infections have been reported concomitantly to deep lymphopenias. OBJECTIVE This study was designed to provide an external and internal analysis of the crossed impacts of PARPi and age on lymphopenia risk. PATIENTS AND METHODS A scoping review was performed on the PubMed and Embase databases to assess the reporting of lymphocyte rates in original studies on PARPi treatment for adult patients up to 1 April 2022. A retrospective cohort was extracted from the medical charts of all patients treated for gynecological cancer at our institution from 2015 to 2022 in accordance with ethical regulations. RESULTS The scoping review research strategy retrieved 5840 abstracts; 225 studies were selected for full-text analysis. Lymphopenia was reported in 41.8% of the studies; frequency of all-grade and grade ≥ 3 lymphopenia reached 20.5% and 8.9%, respectively. Grade ≥ 3 lymphopenia was significantly higher in studies including older patients (median age ≥ 60 years vs. < 60 years), at 7.5% vs. 10.3% (p < 0.0001). PARIB-OLD-HCL included 46 patients, 19 of whom were aged < 70 years (median 44 years) and 27 of whom were aged ≥ 70 years (median 79 years); the frequency of all-grade and grade ≥ 3 lymphopenia reached 67% (< 70 years: 63%; ≥ 70 years: 70%) and 13% (< 70 years: 5%; ≥ 70 years: 19%), respectively. CONCLUSION Lymphopenia events were much more frequent in real-life than in previously reported studies, particularly in older patients. Future work is needed to improve patient follow-up and discuss prophylactic strategies.
Collapse
Affiliation(s)
- Gabriel Antherieu
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Maël Heiblig
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Gilles Freyer
- Department of Medical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Hervé Ghesquieres
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Claire Falandry
- Geriatric Department of Geriatric Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| |
Collapse
|
2
|
Gridelli C, Peters S, Velcheti V, Attili I, de Marinis F. Immunotherapy in the first-line treatment of elderly patients with advanced non-small-cell lung cancer: results of an International Experts Panel Meeting by the Italian Association of Thoracic Oncology (AIOT). ESMO Open 2023; 8:101192. [PMID: 36965261 PMCID: PMC10073636 DOI: 10.1016/j.esmoop.2023.101192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/06/2022] [Accepted: 02/14/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND The use of immune checkpoint inhibitors (ICIs) in the front-line treatment of advanced non-small-cell lung cancer (NSCLC) is currently the standard of care. However, as clinical trials include a very limited number of elderly patients, evidence on the safety and efficacy of using ICI-based regimens is still limited. METHODS A virtual International Expert Panel took place in July 2022 to review the available evidence on the use of ICI-based regimens in the first-line setting in elderly patients with NSCLC and provide a position paper on the field both in clinical practice and in a research setting. RESULTS All panelists agreed that age per se is not a limitation for ICI treatments, as the elderly should be considered only as a surrogate for other clinical factors of frailty. Overall, ICI efficacy in the elderly population is supported by reviewed data. In addition, the panelists were confident that available data support the safety of single-agent immunotherapy in elderly patients with NSCLC. Conversely, concerns were expressed on the safety of chemo + ICI-based combination, which were considered mainly related to the toxicities of chemotherapy components. Therefore, suggestions were proposed to tailor combined approaches in the elderly patients with NSCLC. The panelists defined high, medium, and low priorities in clinical research. High priority was attributed to implementing the real-world assessment of elderly patients treated with ICIs, who are mostly underrepresented in pivotal clinical trials. CONCLUSIONS Based on the current evidence, the panelists outlined the significant limitations affecting the clinical practice in elderly patients affected by NSCLC, and reached common considerations on the feasibility, safety, and effectiveness of ICI monotherapy and ICI combinations in the first-line setting.
Collapse
Affiliation(s)
- C Gridelli
- Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy.
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - V Velcheti
- Perlmutter Cancer Center, New York University (NYU) Langone Health, New York, USA
| | - I Attili
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - F de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| |
Collapse
|
3
|
Chan WL, Chow JCH, Xu ZY, Li J, Kwong WTG, Ng WT, Lee AWM. Management of Nasopharyngeal Carcinoma in Elderly Patients. Front Oncol 2022; 12:810690. [PMID: 35178346 PMCID: PMC8844547 DOI: 10.3389/fonc.2022.810690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/03/2022] [Indexed: 12/27/2022] Open
Abstract
Nasopharyngeal cancer (NPC) is one of the most difficult cancers in the head and neck region due to the complex geometry of the tumour and the surrounding critical organs. High-dose radical radiotherapy with or without concurrent platinum-based chemotherapy is the primary treatment modality. Around 10%–15% of NPC patients have their diagnosis at age after 70. The management of NPC in elderly patients is particularly challenging as they encompass a broad range of patient phenotypes and are often prone to treatment-related toxicities. Chronologic age alone is insufficient to decide on the management plan. Comprehensive geriatric assessment with evaluation on patients’ functional status, mental condition, estimated life expectancy, comorbidities, risks and benefits of the treatment, patients’ preference, and family support is essential. In addition, little data from randomized controlled trials are available to guide treatment decisions in elderly patients with NPC. In deciding which treatment strategy would be suitable for an individual elderly patient, we reviewed the literature and reviewed the analysis of primary studies, reviews, and guidelines on management of NPC. This review also summarises the current evidence for NPC management in elderly adults from early to late stage of disease.
Collapse
Affiliation(s)
- Wing Lok Chan
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - James Chung Hang Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital (QEH), Hong Kong SAR, China
| | - Zhi-Yuan Xu
- Department of Clinical Oncology, Shenzhen Hospital, University of Hong Kong, Shenzhen, China
| | - Jishi Li
- Department of Clinical Oncology, Shenzhen Hospital, University of Hong Kong, Shenzhen, China
| | - Wing Tung Gobby Kwong
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wai Tong Ng
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Anne W M Lee
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| |
Collapse
|
4
|
Chan WL, Marinho J, Chavarri-Guerra Y, Hincapie-Echeverri J, Velasco RN, Akagunduz B, Roy M, Kwong WTG, Wu WF, Battisti NML, Soto-Perez-de-Celis E. Systemic treatment for triple negative breast cancer in older patients: A Young International Society of Geriatric Oncology Review Paper. J Geriatr Oncol 2022; 13:563-571. [DOI: 10.1016/j.jgo.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/04/2022] [Indexed: 12/27/2022]
|
5
|
Battisti NML, Joshi K, Nasser MS, Ring A. Systemic therapy for older patients with early breast cancer. Cancer Treat Rev 2021; 100:102292. [PMID: 34536728 DOI: 10.1016/j.ctrv.2021.102292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/07/2021] [Indexed: 12/16/2022]
Abstract
Over a third of breast cancers are diagnosed in patients ≥70 years. With the ageing of the population, the number of older breast cancer patients will continue to rise. Older patients are under-represented in clinical studies underpinning breast cancer therapy, and frequently do not receive guideline-concordant care. This review outlines the evidence on the efficacy and the safety of systemic treatment options for the management of early-stage breast cancer (EBC) in older adults and identifies where critical data gaps exist. Chemotherapy is beneficial for older patients with oestrogen receptor (ER)-negative EBC, whilst the benefit for those with ER-positive disease is less certain. Careful consideration should be given to the side-effect profile of the treatment regimen chosen, owing to the risks of myelosuppression and cardiac damage, as well as toxicities, such as neuropathy, that may impact independence. The impact of chemotherapy on quality of life (QOL) outcomes appears significant but reversible in this population. Gene expression profiling, benefit and chemotherapy toxicity prediction tools integrating global health considerations hold promise to better inform chemotherapy decisions in this population. Benefits on targeted anti-human epidermal growth factor receptor 2 (HER2) agents is maintained in older EBC patients with a favourable safety profile. Endocrine therapy including aromatase inhibitors is the standard of care in this population, and extended treatment decisions should consider effects on bone health and life expectancy. More trials recruiting older adults with pragmatic designs and meaningful endpoints for this population are warranted to better inform systemic treatment decisions and discussion with patients.
Collapse
Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom.
| | - Kroopa Joshi
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
| | - Mariam Syeda Nasser
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
| | - Alistair Ring
- Department of Medicine - Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
| |
Collapse
|
6
|
Cil I, Kucukarda A, Atcı MM, Secmeler S, Paksoy N, Ferhatoglu F, Ak N, Ayhan M, Tataroglu Ozyukseler D, Onder AH, Avci O, Oyman A, Okten IN, Gulturk I, Akagunduz B, Basoglu T, Cakir E, Hacibekiroglu I, Ozcelik M, Aydiner A. Efficacy and safety of trastuzumab emtansine in older patients with HER2-positive advanced breast cancer: a real-world study. TUMORI JOURNAL 2021; 108:19-25. [PMID: 34365852 DOI: 10.1177/03008916211037739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate and its survival advantage has been shown in advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, clinical trials underrepresent patients ⩾65 years of age, leading to a lack of information in this population. We analyzed the real-world outcomes of older women who were treated with T-DM1 therapy. METHODS We performed a multicenter, observational, retrospective analysis of patients aged ⩾65 years treated with T-DM1. A total of 93 patients from 10 cancer centers were involved in the study. Our goal was to determine the survival, response rates, and toxicity profile in T-DM1-treated patients, as well as the factors that influence survival. RESULTS Median follow-up was 12.2 months. Objective response rate was 29%. Median progression-free survival (PFS) and overall survival (OS) were 8.47 and 15.0 months, respectively. In multivariate analysis, Eastern Cooperative Oncology Group Performance Score 2 was found to be an independent prognostic factor for worse PFS (hazard ratio [HR] 1.81, p = 0.032) and OS (HR 2.33, p = 0.006). Any adverse event (AE) was seen in 92.5% of patients; grade 3 or 4 AEs were seen in 30.1%. Dose reduction or treatment discontinuation rates were 11.8% and 6.5%, respectively. CONCLUSION The efficacy of T-DM1 was acceptable and it was generally well-tolerated among older patients with advanced HER2-positive breast cancer.
Collapse
Affiliation(s)
- Ibrahim Cil
- Department of Medical Oncology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Kucukarda
- Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Muhammed Mustafa Atcı
- Department of Medical Oncology, İstanbul Professor Doctor Cemil Tasçıoğlu City Hospital, İstanbul, Turkey
| | - Saban Secmeler
- Department of Medical Oncology, İstanbul Professor Doctor Cemil Tasçıoğlu City Hospital, İstanbul, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, İstanbul University Oncology Institute, İstanbul, Turkey
| | - Ferhat Ferhatoglu
- Department of Medical Oncology, İstanbul University Oncology Institute, İstanbul, Turkey
| | - Naziye Ak
- Medical Oncology, Yozgat City Hospital, Yozgat, Turkey
| | - Murat Ayhan
- Department of Medical Oncology, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | | | - Arif Hakan Onder
- Department of Medical Oncology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Okan Avci
- Department of Medical Oncology, Namık Kemal University, Tekirdağ, Turkey
| | - Abdilkerim Oyman
- Department of Medical Oncology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ilker Nihat Okten
- Department of Medical Oncology, Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ilkay Gulturk
- Department of Medical Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Baran Akagunduz
- Medical Oncology, Erzincan Binali Yıldırım University, Mengücek Gazi Hospital, Erzincan, Turkey
| | - Tugba Basoglu
- Department of Medical Oncology, Marmara University Pendik Education and Research Hospital, Marmara University School of Medicine, Istanbul, Turkey
| | - Emre Cakir
- Department of Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Ilhan Hacibekiroglu
- Department of Medical Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Melike Ozcelik
- Department of Medical Oncology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, İstanbul University Oncology Institute, İstanbul, Turkey
| |
Collapse
|
7
|
Matsuda K, Jo T, Miyauchi M, Toyama K, Nakazaki K, Matsui H, Fushimi K, Yasunaga H, Kurokawa M. Difference of preventing effects of G-CSF according to age in patients with malignant lymphoma: A nation-wide analysis in Japan. J Infect Chemother 2021; 27:1151-1155. [DOI: 10.1016/j.jiac.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
|
8
|
Systemic therapy for early breast cancer in older adults: current status and prospects. Curr Opin Oncol 2021; 33:574-583. [PMID: 34183493 DOI: 10.1097/cco.0000000000000768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we describe the evidence on the efficacy and the safety of systemic treatments for the management of early breast cancer (EBC) in older individuals. RECENT FINDINGS Chemotherapy has a temporary impact on quality of life (QoL) for older EBC patients and improves survival outcomes for those with oestrogen receptor (ER)-negative disease. Benefits were seen also in the context of comorbidities, although these may be influenced by selection bias. The Cancer and Aging Research Group-Breast Cancer tool can predict the risk of severe toxicities on chemotherapy in older patients. Gene expression profiling is less frequently used in older adults although it holds promise to better inform patient selection also in this age group.Postneoadjuvant systemic therapy and novel agents remain poorly described in older patients with EBC. No disease-free survival benefits were seen in older patients receiving abemaciclib plus adjuvant endocrine therapy. SUMMARY Chemotherapy is beneficial for selected older patients with high-risk, ER-negative EBC. Although its impact on QoL is temporary, preferences, higher risk of toxicity and competing risks need to be carefully considered. Open questions remain on novel therapeutic approaches and gene expression profile in older EBC patients and more real-world evidence is warranted.
Collapse
|
9
|
Quality of life for older patients with cancer: a review of the evidence supporting melatonin use. Aging Clin Exp Res 2020; 32:2459-2468. [PMID: 32236899 PMCID: PMC7680320 DOI: 10.1007/s40520-020-01532-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/07/2020] [Indexed: 12/13/2022]
Abstract
Purpose The proportion of older populations living with cancer is on the increase. Maintaining or improving their quality of life (QoL) has become an important goal in the treatment of cancer and has become an endpoint in clinical trials. Melatonin regulates a wide variety of physiological functions and is involved in the initiation of sleep and the improvement of QoL. With age, the secretion of melatonin decreases and could lead to a deterioration in QoL. Methods Literature searches were conducted using the PubMed database. The search terms and derivatives of “metastatic cancer”, “older patients”, “quality of life” and “melatonin” were used. Titles and abstracts were screened to identify whether studies were relevant for full-text screening. Results There is major concern about the symptoms older cancer patients encounter during treatment because they can impact their QoL. Melatonin supplementation presents several benefits for older patients: improvement in survival, decrease in symptoms induced by cancer and cancer treatment, and also improvements in quality of life. Conclusion It therefore seems appropriate to study the impact of melatonin supplementation during cytotoxic therapy on QoL among elderly patients with metastatic cancer. The use of melatonin as a therapeutic strategy seems particularly suitable for elderly patients, a population known to secrete significantly less melatonin. However, to date, no studies have been conducted in this population.
Collapse
|
10
|
Chan WL, Ma T, Cheung KL, Choi H, Wong J, Lam KO, Yuen KK, Luk MY, Kwong D. The predictive value of G8 and the Cancer and aging research group chemotherapy toxicity tool in treatment-related toxicity in older Chinese patients with cancer. J Geriatr Oncol 2020; 12:557-562. [PMID: 33127385 DOI: 10.1016/j.jgo.2020.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Older patients experience a higher risk of treatment-related toxicity (TRT). The G8 screening tool was developed to separate cancer older patients fit to receive standard treatment from those who are frail and experiencing functional decline due to reduced organ function and multiple comorbidities. The Cancer and Aging Research Group chemotherapy toxicity tool (CARG-tt) questionnaire was developed to predict chemotherapy toxicity in geriatric patients. This prospective observational study evaluated the performance of G8 and CARG-tt in predicting severe TRT in older Chinese cancer patients. METHODS Chinese patients aged ≥65 with a diagnosis of solid malignancy and scheduled to receive anti-cancer treatment (chemotherapy or targeted therapy) were enrolled from March 2016 to July 2017 at the Department of Clinical Oncology at Queen Mary Hospital in Hong Kong. All patients completed the G8 and CARG-tt screening and pre-treatment assessments before starting treatment. Patients were monitored for any severe TRT, which was defined by grades 3-5 using the National Cancer Institute's Common Terminology Criteria for Adverse Events v4.03, treatment discontinuation, or unexpected hospitalization from starting to 30 days after treatment. RESULTS A total of 259 patients (male: 154, 59.5%; median age: 73.4, age range: 65-93) were enrolled in the study. Two hundred and ten (81.1%) patients received chemotherapy while the rest (n = 49, 18.9%) received targeted therapy. Overall, 146 patients (56.8%) experienced severe TRT. The mean G8 score was 12.4 (SD: 2.8). The G8 score had a significant association with unexpected admission (cutoff: 14, 41.3% vs. 26.5%, p = 0.03) but not significant in other types of TRTs. The mean CARG-tt score was 7.67 (SD: 3.7); it was not associated with severe TRTs. CONCLUSIONS The G8 and CARG-tt demonstrated a weak prediction of severe TRT in older Chinese cancer patients. Future studies need to develop predictive tools for TRT in patients receiving novel antineoplastic therapies, with a focus on subgroup analysis for different populations.
Collapse
Affiliation(s)
- Wing-Lok Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong.
| | - Tiffany Ma
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | | | - Horace Choi
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - Josiah Wong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - Ka-On Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Mai-Yee Luk
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Dora Kwong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| |
Collapse
|
11
|
Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group. J Geriatr Oncol 2020; 11:1190-1198. [PMID: 32709495 PMCID: PMC7365054 DOI: 10.1016/j.jgo.2020.07.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 12/25/2022]
Abstract
The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.
Collapse
|
12
|
A systematic review and network meta-analysis of phase III randomised controlled trials for adjuvant therapy following resection of pancreatic ductal adenocarcinoma (PDAC). HPB (Oxford) 2020; 22:649-659. [PMID: 31894014 DOI: 10.1016/j.hpb.2019.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several randomised controlled trials (RCTs) have reported various systemic adjuvant therapy regimens following resection of pancreatic ductal adenocarcinoma (PDAC). The most commonly applied include modified FOLFRINOX (mFFX), Gemcitabine/Capecitabine (GemCap) and S1, usually compared to gemcitabine (Gem) alone. However, many of these regimens have not been directly compared in RCTs. This network meta-analysis aims to characterise the impact of adjuvant therapies on overall and disease-free survival in patients having resection of PDAC. METHODS A systematic review was conducted using MEDLINE, EMBASE, Cochrane Central and American Society of Clinical Oncology (ASCO) abstracts to identify published phase III RCTs articles up to 9th May 2019 that examined adjuvant systemic therapy in resected pancreatic cancer. Data including study characteristics and outcomes including overall survival (OS) and disease-free survival (DFS) were extracted. Indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analyses (NMA) which maintains randomisation within trials. RESULTS Twelve phase III RCTs involving 4947 patients and nine different regimens (5-Flourouracil/Folinic acid (5-FU/FA), Gemcitabine, Gemcitabine/Erlotinib (GemErl), GemCap), mFFX, S1, chemoradiotherapy (CRT), CRT with either 5-FU or Gemcitabine) were identified. S1 was ranked best for overall and disease-free survival followed by mFFX. Whilst there were no significant difference between S1 and mFFX for overall survival (mean difference: 1.6 months, p = 0.8), S1 had significantly longer disease-free survival than mFFX (mean difference: 2.8 months, p < 0.001). Furthermore, S1 was ranked best for lowest overall and haematological grade 3/4 toxicities. CONCLUSION This network meta-analysis demonstrates that chemotherapy with S1 or mFFX is superior to GemCap for adjuvant treatment for PDAC, improves survival after surgical resection and should be considered as reasonable standard treatment options in the adjuvant setting and as control arm for future adjuvant clinical trials.
Collapse
|
13
|
Figueroa Gonzalez D, Young F. Gamma Tocopherol Reduced Chemotherapeutic-Induced ROS in an Ovarian Granulosa Cell Line, But Not in Breast Cancer Cell Lines In Vitro. Antioxidants (Basel) 2020; 9:antiox9010051. [PMID: 31936058 PMCID: PMC7023168 DOI: 10.3390/antiox9010051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 01/13/2023] Open
Abstract
Doxorubicin and cyclophosphamide are used to treat breast cancer, but they also cause infertility through off-target cytotoxicity towards proliferating granulosa cells that surround eggs. Each chemotherapeutic generates reactive oxygen species (ROS) but the effects of the combination, or the antioxidants alpha (αToc) and gamma tocopherol (γToc) on ROS in breast cancer or ovarian cells are unknown. Human breast cancer (MCF7, T47D) and ovarian cancer (OVCAR, COV434) cells were loaded with DCDFA and exposed (1, 2, 3, 24 h) to the MCF7-derived EC25 values of individual agents, or to combinations of these. ROS were quantified and viable cells enumerated using crystal violet or DAPI. Each chemotherapeutic killed ~25% of MCF7, T47D and OVCAR cells, but 57 ± 2% (doxorubicin) and 66 ± 2% (cyclophosphamide) of the COV434 granulosa cells. The combined chemotherapeutics decreased COV434 cell viability to 34 ± 5% of control whereas doxorubicin + cyclophosphamide + γToc reduced ROS within 3 h (p < 0.01) and reduced cytotoxicity to 54 ± 4% (p < 0.05). αToc was not cytotoxic, whereas γToc killed ~25% of the breast cancer but none of the ovarian cells. Adding γToc to the combined chemotherapeutics did not change ROS or cytotoxicity in MCF7, T47D or OVCAR cells. The protection γToc afforded COV434 granulosa cells against chemotherapy-induced ROS and cytotoxicity suggests potential for fertility preservation.
Collapse
|
14
|
Effect of Chemotherapeutics and Tocopherols on MCF-7 Breast Adenocarcinoma and KGN Ovarian Carcinoma Cell Lines In Vitro. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6146972. [PMID: 30766885 PMCID: PMC6350544 DOI: 10.1155/2019/6146972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/28/2018] [Accepted: 12/30/2018] [Indexed: 02/04/2023]
Abstract
The combination of doxorubicin and cyclophosphamide commonly used to treat breast cancer can cause premature ovarian failure and infertility. α-Tocopherol is a potent antioxidant whereas γ-tocopherol causes apoptosis in a variety of cancer models in vitro including breast cancer. We hypothesised that the combination of doxorubicin (Dox) and 4-hydroperoxycyclophosphamide (4-Cyc) would be more cytotoxic in vitro than each agent alone, and that α-tocopherol would reduce and γ-tocopherol would augment the cytotoxicity of the combined chemotherapeutics. Human MCF-7 breast cancer and KGN ovarian cells were exposed to Dox, 4-Cyc, combined Dox and 4-Cyc, α-tocopherol, γ-tocopherol, or a combination of Dox and 4-Cyc with α-tocopherol or γ–tocopherol. Cell viability was assessed using a crystal violet assay according to four schedules: 24h exposure, 24h exposure + 24h culture in medium, 24h exposure + 48h culture in medium, or 72h continuous exposure. Supernatants from each separate KGN culture experiment (n=3) were examined using an estradiol ELISA. Dox was cytotoxic to both MCF-7 and KGN cells, but 4-Cyc only killed MCF-7 cells. γ-Tocopherol significantly decreased MCF-7 but not KGN cell viability. The combined chemotherapeutics and γ-tocopherol were more cytotoxic to MCF-7 than KGN cells, and α-tocopherol reduced the cytotoxicity of the combined chemotherapeutics towards KGN ovarian cells, but not MCF-7 cells. The addition of both γ-tocopherol and α-tocopherol to the chemotherapeutic combination of Dox and cyclophosphamide has the potential to increase in vitro chemotherapeutic efficacy against breast cancer cells whilst decreasing cytotoxicity towards ovarian granulosa cells.
Collapse
|
15
|
Almodovar T, Teixeira E, Barroso A, Soares M, Queiroga H, Cavaco-Silva J, Barata F. Elderly patients with advanced NSCLC: The value of geriatric evaluation and the feasibility of CGA alternatives in predicting chemotherapy toxicity. Pulmonology 2019; 25:40-50. [DOI: 10.1016/j.pulmoe.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/19/2018] [Indexed: 12/16/2022] Open
|
16
|
Huang C, Zhu Y, Li Q, Zhang W, Liu H, Zhang W, Hu Y, Yuan Y, Liu M. Feasibility and efficiency of concurrent chemoradiotherapy with a single agent or double agents vs radiotherapy alone for elderly patients with esophageal squamous cell carcinoma: Experience of two centers. Cancer Med 2019; 8:28-39. [PMID: 30600600 PMCID: PMC6346235 DOI: 10.1002/cam4.1788] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 12/22/2022] Open
Abstract
The incidence of elderly patients with esophageal cancer (OC) is increasing as the population ages. Until now, the treatment strategy in these patients has been unclear. The aim of our study was to assess the efficiency and tolerance of treatment with radiotherapy alone (RT alone), single‐agent‐based concurrent chemoradiotherapy (CCRT‐1), or double‐agent‐based concurrent chemoradiotherapy (CCRT‐2) in elderly patients (≥65 years) with OC. A total of 271 patients with OC aged 65 years or older were included in this study. The median overall survival (OS), median progression‐free survival (PFS), overall response rate (ORR), disease control rate (DCR), and treatment‐related toxicities were assessed. The median OS time for all patients was 23.6 ± 2.3 months, with 2‐year survival rates of 48.0 ± 3.0%. The median PFS time was 13.6 ± 1.3 months with the 2‐year PFS rate was 33.0 ± 4.0%. Among patients who received CCRT‐1, better OS, and PFS were found in patients who received docetaxel than in patients received fluorouracil and platinum. In a subgroup analysis, 118 patients who underwent RT alone had a median OS time of 15.6 ± 1.9 months and median PFS time of 10.4 ± 0.9 months. The median OS time of patients who received CCRT‐1 was 28.8 ± 10.1 months compared with 27.8 ± 2.5 months for the patients treated with CCRT‐2 (P = 0.537). The similar results were observed for median PFS, with 16.5 ± 3.2 months in the CCRT‐1 group and 17.0 ± 2.0 months in the CCRT‐2 group (P = 0.321). Grade ≥3 leukocytopenia and grade ≥2 weight loss during treatment occurred in 40.6% and 17.9% of patients, respectively, in the CCRT‐2 group, which was higher than that observed in the CCRT‐1 group. Our results suggested that CCRT could be considered as an acceptable treatment for elderly patients with OC. The CCRT‐1 group presented with a lower incidence of treatment toxicities but comparable survival outcomes, compared to the CCRT‐2 group. Docetaxel was superior to fluorouracil and platinum in terms of OS.
Collapse
Affiliation(s)
- Chunyue Huang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yujia Zhu
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qiwen Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenwen Zhang
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Weijun Zhang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yonghong Hu
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yawei Yuan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Mengzhong Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
17
|
Predicting 90-Day Mortality in Locoregionally Advanced Head and Neck Squamous Cell Carcinoma after Curative Surgery. Cancers (Basel) 2018; 10:cancers10100392. [PMID: 30360381 PMCID: PMC6210656 DOI: 10.3390/cancers10100392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/13/2018] [Accepted: 10/18/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose: To propose a risk classification scheme for locoregionally advanced (Stages III and IV) head and neck squamous cell carcinoma (LA-HNSCC) by using the Wu comorbidity score (WCS) to quantify the risk of curative surgeries, including tumor resection and radical neck dissection. Methods: This study included 55,080 patients with LA-HNSCC receiving curative surgery between 2006 and 2015 who were identified from the Taiwan Cancer Registry database; the patients were classified into two groups, mortality (n = 1287, mortality rate = 2.34%) and survival (n = 53,793, survival rate = 97.66%), according to the event of mortality within 90 days of surgery. Significant risk factors for mortality were identified using a stepwise multivariate Cox proportional hazards model. The WCS was calculated using the relative risk of each risk factor. The accuracy of the WCS was assessed using mortality rates in different risk strata. Results: Fifteen comorbidities significantly increased mortality risk after curative surgery. The patients were divided into low-risk (WCS, 0–6; 90-day mortality rate, 0–1.57%), intermediate-risk (7–11; 2.71–9.99%), high-risk (12–16; 17.30–20.00%), and very-high-risk (17–18 and >18; 46.15–50.00%) strata. The 90-day survival rates were 98.97, 95.85, 81.20, and 53.13% in the low-, intermediate-, high-, and very-high-risk patients, respectively (log-rank p < 0.0001). The five-year overall survival rates after surgery were 70.86, 48.62, 22.99, and 18.75% in the low-, intermediate-, high-, and very-high-risk patients, respectively (log-rank p < 0.0001). Conclusion: The WCS is an accurate tool for assessing curative-surgery-related 90-day mortality risk and overall survival in patients with LA-HNSCC.
Collapse
|
18
|
Ruiz J, Miller AA, Tooze JA, Crane S, Petty WJ, Gajra A, Klepin HD. Frailty assessment predicts toxicity during first cycle chemotherapy for advanced lung cancer regardless of chronologic age. J Geriatr Oncol 2018; 10:48-54. [PMID: 30005982 DOI: 10.1016/j.jgo.2018.06.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improved assessment strategies are needed to individualize treatment for adults of all ages receiving palliative chemotherapy for non-small cell lung cancer (NSCLC). Our aim was to evaluate the utility of the Fried Frailty Index (FFI) and a cancer-specific geriatric assessment (GA) to predict chemotherapy toxicity and overall survival (OS). METHODS We conducted a multi-site pilot study of 50 patients with newly diagnosed advanced NSCLC, age ≥ 18 years. All participants received carboplatin AUC 6, paclitaxel 200 mg/m2 every 3 weeks. FFI and the GA were administered prior to chemotherapy. A GA toxicity risk score was calculated. Grade 3-5 toxicity was assessed during 1st two cycles of chemotherapy. OS was measured from chemotherapy initiation. Logistic regression and Cox proportional hazards models were fit to estimate the association between baseline characteristics and toxicity and OS respectively. RESULTS Among 50 participants, 48 received chemotherapy and were evaluable. The mean age was 68.5 y (range 42-86), 79% male, 85% KPS ≥80. The median OS was 8 months. Many (27%) met FFI criteria for frailty with ≥3 impairments. Impairments detected by the GA were common. In multivariable analyses both FFI ≥ 3 and GA toxicity risk score > 7 were independently associated with higher odds of toxicity (Odds ratio [OR] 7.0; 95% confidence interval [CI] 1.1-44.6 and OR 4.3; 95% CI 1.0-17.7, respectively) in first cycle chemotherapy. Neither score was associated with OS. CONCLUSIONS Frailty predicts chemotherapy toxicity during first cycle. Frailty assessment may inform toxicity risk regardless of chronologic age.
Collapse
Affiliation(s)
- Jimmy Ruiz
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA
| | - Antonius A Miller
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA; W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, USA
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sandrine Crane
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William J Petty
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ajeet Gajra
- Department of Medicine, Syracuse VA Medical Center, Hematology/Oncology, Syracuse, NY USA
| | - Heidi D Klepin
- Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
19
|
Del Mastro L, Maggi E, Catzeddu T, Hazini A, Bell C. Is it Possible to use Anthracyclines in Patients Older than 70 Years? Contra. TUMORI JOURNAL 2018; 88:S136-7. [PMID: 11989908 DOI: 10.1177/030089160208800140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
20
|
Cheng KKF, Lim EYT, Kanesvaran R. Quality of life of elderly patients with solid tumours undergoing adjuvant cancer therapy: a systematic review. BMJ Open 2018; 8:e018101. [PMID: 29371271 PMCID: PMC5786145 DOI: 10.1136/bmjopen-2017-018101] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The measurement of quality of life (QoL) in elderly cancer population is increasingly being recognised as an important element of clinical decision-making and the evaluation of treatment outcome. This systematic review aimed to summarise the evidence of QoL during and after adjuvant therapy in elderly patients with cancer. METHODS A systematic search was conducted of studies published in CINAHL plus, CENTRAL, PubMed, PsycINFO and Web of Science from the inception of these databases to December 2016. Eligible studies included RCTs and non-RCTs in which QoL was measured in elderly patients (aged 65 years or above) with stage I-III solid tumours who were undergoing adjuvant chemotherapy and/or radiotherapy. Because of the heterogeneity and the insufficient data among the included studies, the results were synthesised narratively. RESULTS We included 4 RCTs and 14 non-RCTs on 1785 participants. In all four RCTs, the risk of bias was low or unclear for most items but high for detection. Of the 14 non-RCTs, 5 studies were judged to have a low or moderate risk of bias for all domains, and the other 9 studies had a serious risk of bias in at least one domain. The bias was observed mainly in the confounding and in the selection of participants for the study. For most elderly patients with breast cancer, the non-significant negative change in the QoL was transient. A significant increase in the QoL during the course of temozolomide in elderly patients with glioblastoma but a decreasing trend in QoL after radiotherapy was shown. This review also shows a uniform trend of stable or improved QoL during adjuvant therapy and at follow-up evaluations across the studies with prostate, colon or cervical cancer population. CONCLUSIONS This review suggests that adjuvant chemotherapy and radiotherapy may not have detrimental effects on QoL in most elderly patients with solid tumours.
Collapse
Affiliation(s)
- Karis Kin-Fong Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Ethel Yee-Ting Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | | |
Collapse
|
21
|
Abstract
Background The number of individuals aged 65 years and older is growing rapidly, and the majority of cancers are diagnosed in this age group. Age-related changes in physiology can affect chemotherapy pharmacokinetics and pharmacodynamics in older patients. Methods We review the literature regarding the impact of age on the pharmacokinetics of commonly used chemotherapy drugs and discuss age-related changes in physiology and pharmacology that can affect chemotherapy tolerance in older patients. Results The data on age-related changes in chemotherapy pharmacokinetics are conflicting. While a few studies report age-related differences in chemotherapy pharmacokinetics, most found no significant difference or subtle differences in pharmacokinetics with aging. A difference in pharmacodynamics was commonly seen, however, with older patients at increased risk of myelosuppression and toxicity from age-related decline in organ function. The majority of these studies were performed in a small cohort of patients, thus limiting the generalizability of these results. Conclusions Additional studies are needed to address the pharmacokinetics and pharmacodynamics of cancer therapies in the older patient. Multicenter pharmacokinetic studies of adequate sample size, which include a thorough evaluation of physiologic factors and geriatric assessment parameters, would provide further insight into the factors affecting treatment tolerance. These studies would also help to guide appropriate chemotherapy dosing and interventions in order to maximize efficacy and minimize toxicity in the older patient.
Collapse
Affiliation(s)
- Arti Hurria
- Cancer and Aging Research Program, City of Hope National Medical Center, Duarte, CA 91010, USA.
| | | |
Collapse
|
22
|
|
23
|
Yuan Y, Vora N, Sun CL, Li D, Soto-Perez-de-Celis E, Mortimer J, Luu TH, Somlo G, Waisman J, Smith D, Chao J, Katheria V, Synold T, Tran V, Mi S, Levi A, Arsenyan A, Choi J, Zavala L, Yost S, Hurria A. Association of pre-chemotherapy peripheral blood pro-inflammatory and coagulation factors with reduced relative dose intensity in women with breast cancer. Breast Cancer Res 2017; 19:101. [PMID: 28851415 PMCID: PMC5576099 DOI: 10.1186/s13058-017-0895-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Chemotherapy decreases the risk of relapse and mortality in early-stage breast cancer (BC), but it comes with the risk of toxicity. Chemotherapy efficacy depends on relative dose intensity (RDI), and an RDI < 85% is associated with worse overall survival. The pro-inflammatory (interleukin (IL)-6, C-reactive protein (CRP)) and coagulation factors (D-dimer) serve as biomarkers of aging. The purpose of this study is to determine if these biomarkers are associated with reduced RDI in women with stage I–III BC. Methods This study enrolled women with stage I–III BC. Prior to adjuvant or neoadjuvant chemotherapy, peripheral blood was collected for biomarker measurement. Dose reductions and delays were captured and utilized to calculate the RDI delivered. Univariate and multivariate analyses were performed to describe the association between pre-chemotherapy IL-6, CRP, and D-dimer levels and an RDI < 85%, controlling for relevant tumor and patient factors (age, stage, receptor status, chemotherapy regimen, and pre-chemotherapy physical function and comorbidity). Results A total of 159 patients (mean age 58 years, range 30–81, SD 11.3) with stage I–III BC were enrolled. An RDI < 85% occurred in 22.6% (N = 36) of patients and was associated with higher pre-chemotherapy IL-6 (OR 1.14, 95% CI 1.04–1.25; p = 0.006) and D-dimer (OR 2.32, 95% CI 1.27–4.24; p = 0.006) levels, increased age (p = 0.001), increased number of comorbidities (p = 0.01), and decreased physical function by the Medical Outcomes Survey Activities of Daily Living (ADL) Scale (p = 0.009) in univariate analysis. A multivariate model, including two biomarkers (IL-6 and D-dimer), age, ADL, BC stage, and chemotherapy regimen, demonstrated a significant association between the increased biomarkers and reduced RDI < 85% (OR 2.54; p = 0.04). Conclusions Increased pre-chemotherapy biomarkers of aging (IL-6 and D-dimer) are associated with reduced RDI (<85%). Future studies are underway to validate these findings. Trial registration ClinicalTrials.gov, NCT01030250. Registered on 3 November 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13058-017-0895-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yuan Yuan
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA.
| | - Nilesh Vora
- Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Can-Lan Sun
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Daneng Li
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | | | - Joanne Mortimer
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - The-Hang Luu
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - George Somlo
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - James Waisman
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - David Smith
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Joseph Chao
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Vani Katheria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Timothy Synold
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Vivi Tran
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Shu Mi
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Abrahm Levi
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Anait Arsenyan
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Jennifer Choi
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Laura Zavala
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Susan Yost
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA
| |
Collapse
|
24
|
Calvo E, Walko C, Dees EC, Valenzuela B. Pharmacogenomics, Pharmacokinetics, and Pharmacodynamics in the Era of Targeted Therapies. Am Soc Clin Oncol Educ Book 2017; 35:e175-84. [PMID: 27249721 DOI: 10.1200/edbk_159061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The complex nature of the pharmacologic aspects of cancer therapeutics has become more apparent in the past several years with the arrival of a cascade of target-based agents and the difficult challenge of bringing individualized precision medicine to oncology. Interpatient variability in drug action, singularly in novel agents, is in part caused by pharmacogenomic (PG), pharmacokinetic, and pharmacodynamic (PD) factors, and drug selection and dosing should take this into consideration to optimize the benefit for our patients in terms of antitumor activity and treatment tolerance. In this regard, somatic genetic evaluation of tumors is useful in not only predicting response to initial targeted therapies but also in anticipating and guiding therapy after the development of acquired resistance; therapeutic drug monitoring of novel small molecules and monoclonal antibodies must be incorporated in our day-to-day practice to minimize the negative effect on clinical outcome of interindividual variability on pharmacokinetic processes of these drugs for all patients, but especially for fragile patient populations and those with organ dysfunction or comorbidities. For these populations, incorporating frailty assessment tools into trials of newer agents and validating frailty-based dose adjustment should be an important part of further drug development.
Collapse
Affiliation(s)
- Emiliano Calvo
- From the DeBartolo Family Personalized Medicine Institute, H. Lee Moffitt Cancer Center, Tampa, FL; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Platform of Oncology, Hospital Quirón, Torrevieja, Alicante, Spain; START Madrid, Early Clinical Drug Development Program, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Christine Walko
- From the DeBartolo Family Personalized Medicine Institute, H. Lee Moffitt Cancer Center, Tampa, FL; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Platform of Oncology, Hospital Quirón, Torrevieja, Alicante, Spain; START Madrid, Early Clinical Drug Development Program, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - E Claire Dees
- From the DeBartolo Family Personalized Medicine Institute, H. Lee Moffitt Cancer Center, Tampa, FL; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Platform of Oncology, Hospital Quirón, Torrevieja, Alicante, Spain; START Madrid, Early Clinical Drug Development Program, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Belén Valenzuela
- From the DeBartolo Family Personalized Medicine Institute, H. Lee Moffitt Cancer Center, Tampa, FL; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Platform of Oncology, Hospital Quirón, Torrevieja, Alicante, Spain; START Madrid, Early Clinical Drug Development Program, Centro Integral Oncológico Clara Campal, Madrid, Spain
| |
Collapse
|
25
|
Jerzak KJ, Desautels DN, Pritchard KI. An update on adjuvant systemic therapy for elderly patients with early breast cancer. Expert Opin Pharmacother 2016; 17:1881-8. [PMID: 27539883 DOI: 10.1080/14656566.2016.1219339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Elderly women with early breast cancer require an individualized approach to risk assessment and treatment. Unfortunately, there are limited data to inform optimal adjuvant therapy decisions in this population. Cytotoxic chemotherapy, biologic treatments and endocrine agents, while important in reducing breast cancer recurrence and mortality, are associated with the potential for adverse effects that may be of particular significance to elderly patients. AREAS COVERED In this review, we summarize the evidence for geriatric assessment in elderly patients with early breast cancer, outline special considerations for the use of chemotherapy and trastuzumab in older adults, and describe the age-specific risks of endocrine therapy in the adjuvant breast cancer setting. EXPERT OPINION The treatment of elderly women with early breast cancer should take into account cancer risk, life expectancy, comorbidities, functional status, physiologic changes, and patient values. Formal geriatric assessment may better inform treatment recommendations for individual patients. In general, there is no strong evidence to suggest that older women benefit less from standard adjuvant therapies than do their younger counterparts. When choosing between endocrine therapies, the differential risks associated with each agent should be considered and particular attention to the fracture risk on aromatase inhibitors (AIs) is warranted. Enrolment of women over 70 years of age into breast cancer clinical trials should be encouraged to better inform treatment guidelines.
Collapse
|
26
|
Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A, Feng T, Smith D, Sun CL, De Glas N, Cohen HJ, Katheria V, Doan C, Zavala L, Levi A, Akiba C, Tew WP. Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer. J Clin Oncol 2016; 34:2366-71. [PMID: 27185838 DOI: 10.1200/jco.2015.65.4327] [Citation(s) in RCA: 415] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Older adults are at increased risk for chemotherapy toxicity, and standard oncology assessment measures cannot identify those at risk. A predictive model for chemotherapy toxicity was developed (N = 500) that consisted of geriatric assessment questions and other clinical variables. This study aims to externally validate this model in an independent cohort (N = 250). PATIENTS AND METHODS Patients age ≥ 65 years with a solid tumor, fluent in English, and who were scheduled to receive a new chemotherapy regimen were recruited from eight institutions. Risk of chemotherapy toxicity was calculated (low, medium, or high risk) on the basis of the prediction model before the start of chemotherapy. Chemotherapy-related toxicity was captured (grade 3 [hospitalization indicated], grade 4 [life threatening], and grade 5 [treatment-related death]). Validation of the prediction model was performed by calculating the area under the receiver-operating characteristic curve. RESULTS The study sample (N = 250) had a mean age of 73 years (range, 65 to 94 [standard deviation, 5.8]). More than one half of patients (58%) experienced grade ≥ 3 toxicity. Risk of toxicity increased with increasing risk score (36.7% low, 62.4% medium, 70.2% high risk; P < .001). The area under the curve of the receiver-operating characteristic curve was 0.65 (95% CI, 0.58 to 0.71), which was not statistically different from the development cohort (0.72; 95% CI, 0.68 to 0.77; P = .09). There was no association between Karnofsky Performance Status and chemotherapy toxicity (P = .25). CONCLUSION This study externally validated a chemotherapy toxicity predictive model for older adults with cancer. This predictive model should be considered when discussing the risks and benefits of chemotherapy with older adults.
Collapse
Affiliation(s)
- Arti Hurria
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Supriya Mohile
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ajeet Gajra
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Heidi Klepin
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hyman Muss
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Andrew Chapman
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tao Feng
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - David Smith
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Can-Lan Sun
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Nienke De Glas
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Harvey Jay Cohen
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Vani Katheria
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Caroline Doan
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Laura Zavala
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Abrahm Levi
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - Chie Akiba
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| | - William P Tew
- Arti Hurria, Tao Feng, David Smith, Can-Lan Sun, Vani Katheria, Caroline Doan, Laura Zavala, Abrahm Levi, and Chie Akiba, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA; Supriya Mohile, University of Rochester Medical Center, Rochester; Ajeet Gajra, Upstate Medical University and Syracuse VA Medical Center, Syracuse; William P. Tew, Memorial Sloan Kettering Cancer Center, New York, NY; Heidi Klepin, Wake Forest University School of Medicine, Winston Salem; Hyman Muss, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill; Harvey Jay Cohen, Duke University, Durham, NC; Andrew Chapman, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; and Nienke De Glas, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
27
|
Drooger JC, Heemskerk-Gerritsen BAM, Smallenbroek N, Epskamp C, Seynaeve CM, Jager A. Toxicity of (neo)adjuvant chemotherapy for BRCA1- and BRCA2-associated breast cancer. Breast Cancer Res Treat 2016; 156:557-566. [PMID: 27060914 PMCID: PMC4837227 DOI: 10.1007/s10549-016-3777-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/30/2016] [Indexed: 01/16/2023]
Abstract
Treatment with (neo)adjuvant chemotherapy for breast cancer, as currently given, causes cell damage by induction of double-strand DNA breaks. Because BRCA1 and BRCA2 proteins play a role in the repair of DNA damage, the efficacy of (neo)adjuvant chemotherapy may be increased in BRCA1/2-associated breast cancer patients. As a downside, acute chemotherapy-related toxicity may also be increased. We selected all female patients who were treated at the Erasmus MC Cancer Institute, with (neo)adjuvant chemotherapy for primary or locoregional recurrence of breast cancer (PBC/LR) between January 1, 2004 and December 31, 2014. The primary outcome was the relative total dose intensity (RTDI), calculated for anthracyclines and taxanes separately. Secondary outcomes were the occurrence of febrile neutropenia, delay in chemotherapy administration, and switch to another chemotherapy regimen due to toxicity. In total, 701 patients treated for PBC/LR were eligible for data analyses, among which 85 BRCA1/2 mutation carriers (n = 67 BRCA1 and n = 18 BRCA2). The mean RTDI for anthracyclines was not significantly different between both groups (98.7 % in the BRCA1/2, 96.6 % in the sporadic group, p = 0.27). Also the mean RTDI for taxanes was not significantly different between the groups (93.6 % in the BRCA1/2-associated, 90.0 % in the sporadic group, p = 0.12). Linear regression analysis revealed no significant effect of BRCA1/2 mutation carriership on the RTDIs. No significant differences were found in the percentages of patients presenting with febrile neutropenia, having a delay in chemotherapy administration or switching to an altered chemotherapy regimen. Additionally, the odds ratios showed no significant effect of BRCA1/2 mutation carriership on the secondary outcome variables. (Neo)adjuvant chemotherapy-related toxicity was not different between BRCA1/2-associated and sporadic breast cancer patients suggesting that the DNA damage repair mechanism of non-cancer cells with only one normal copy of either the BRCA1 or BRCA2 gene is sufficiently functional to handle acute chemotherapy-associated toxicity.
Collapse
Affiliation(s)
- Jan C Drooger
- Department of Medical Oncology, Erasmus MC Cancer Institute and Cancer Genomics Netherlands, PO Box 5201, 3008, AE, Rotterdam, The Netherlands. .,Department of Medical Oncology, Ikazia Hospital, Rotterdam, The Netherlands.
| | - Bernadette A M Heemskerk-Gerritsen
- Department of Medical Oncology, Erasmus MC Cancer Institute and Cancer Genomics Netherlands, PO Box 5201, 3008, AE, Rotterdam, The Netherlands
| | - Nyrée Smallenbroek
- Department of Medical Oncology, Erasmus MC Cancer Institute and Cancer Genomics Netherlands, PO Box 5201, 3008, AE, Rotterdam, The Netherlands
| | - Cynthia Epskamp
- Department of Medical Oncology, Erasmus MC Cancer Institute and Cancer Genomics Netherlands, PO Box 5201, 3008, AE, Rotterdam, The Netherlands.,Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Caroline M Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute and Cancer Genomics Netherlands, PO Box 5201, 3008, AE, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute and Cancer Genomics Netherlands, PO Box 5201, 3008, AE, Rotterdam, The Netherlands
| |
Collapse
|
28
|
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
|
29
|
Pharmacokinetics of Selected Anticancer Drugs in Elderly Cancer Patients: Focus on Breast Cancer. Cancers (Basel) 2016; 8:cancers8010006. [PMID: 26729170 PMCID: PMC4728453 DOI: 10.3390/cancers8010006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/30/2015] [Accepted: 12/29/2015] [Indexed: 01/07/2023] Open
Abstract
Background: Elderly patients receiving anticancer drugs may have an increased risk to develop treatment-related toxicities compared to their younger peers. However, a potential pharmacokinetic (PK) basis for this increased risk has not consistently been established yet. Therefore, the objective of this study was to systematically review the influence of age on the PK of anticancer agents frequently administered to elderly breast cancer patients. Methods: A literature search was performed using the PubMed electronic database, Summary of Product Characteristics (SmPC) and available drug approval reviews, as published by EMA and FDA. Publications that describe age-related PK profiles of selected anticancer drugs against breast cancer, excluding endocrine compounds, were selected and included. Results: This review presents an overview of the available data that describe the influence of increasing age on the PK of selected anticancer drugs used for the treatment of breast cancer. Conclusions: Selected published data revealed differences in the effect and magnitude of increasing age on the PK of several anticancer drugs. There may be clinically-relevant, age-related PK differences for anthracyclines and platina agents. In the majority of cases, age is not a good surrogate marker for anticancer drug PK, and the physiological state of the individual patient may better be approached by looking at organ function, Charlson Comorbidity Score or geriatric functional assessment.
Collapse
|
30
|
Adjuvant regimens with trastuzumab administered for small HER2-positive breast cancer in routine clinical practice. Clin Transl Oncol 2015; 17:862-9. [DOI: 10.1007/s12094-015-1316-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/29/2015] [Indexed: 11/27/2022]
|
31
|
The risk factors of toxicity during chemotherapy and radiotherapy in breast cancer patients according to the presence of BRCA gene mutation. Contemp Oncol (Pozn) 2015. [PMID: 26199574 PMCID: PMC4507882 DOI: 10.5114/wo.2015.50014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim of the study Treatment toxicity may decrease the treatment effectiveness due to the need to reduce the dose or increase the interval between cycles. The aim of this study was to distinguish the risk factors for treatment side effects in breast cancer patients and to assess the impact of BRCA1/2 mutations on the treatment toxicity. Material and methods The analysis was conducted on the medical history of 370 patients who were treated with anthracycline-based chemotherapy between 2006 and 2012 in the Clinical Oncology Department, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology in Gliwice in Poland (COI). All patients were tested for the presence of BRCA1 and BRCA2 mutations. Results In the studied group 13% (48) of the patients were BRCA mutation carriers. Neutropaenia after the first cycle of chemotherapy occurred more commonly in mutation carriers compared to non-carriers (29% vs. 10%), p = 0.0002. Radiotherapy acute skin toxicity was present in 3% of patients with similar rates in both groups, p = 0.950. Toxicity grade 3–4 was present more frequently in patients younger than 70 years (p = 0.02) of age, patients with viral hepatitis (p = 0.045), hypertension (p = 0.039), and cardiovascular disease (p = 0.044). Lower WBC count before treatment was observed more frequently in patients with neutropaenia (p = 0.002), especially in mutation carriers, p = 0.0015. Conclusions Risk factors for anthracycline-based chemotherapy side effects were: age below 70 years, lower WBC value at baseline, history of infectious diseases, hypertension, and cardiovascular comorbidity. The presence of BRCA mutations may be a risk factor for neutropaenia, but it did not affect radiotherapy toxicity.
Collapse
|
32
|
Mountzios G. Optimal management of the elderly patient with head and neck cancer: Issues regarding surgery, irradiation and chemotherapy. World J Clin Oncol 2015; 6:7-15. [PMID: 25667910 PMCID: PMC4318746 DOI: 10.5306/wjco.v6.i1.7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
Head and neck cancer (HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.
Collapse
|
33
|
Zhu GQ, Shi KQ, You J, Zou H, Lin YQ, Wang LR, Braddock M, Chen YP, Zheng MH. Systematic review with network meta-analysis: adjuvant therapy for resected biliary tract cancer. Aliment Pharmacol Ther 2014; 40:759-70. [PMID: 25099956 DOI: 10.1111/apt.12900] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/05/2014] [Accepted: 07/06/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major adjuvant therapies for biliary tract cancer (BTC) include fluorouracil, gemcitabine and chemoradiation (CRT), but the optimum regimen remains inconclusive. AIM To compare these therapies in terms of patient survival rates after resection and toxic effects. METHODS We searched PubMed for controlled trials comparing the above three therapies with each other or observation alone until 31 January 2014. We estimated the hazard ratios (HRs) for death and odds ratios (ORs) for toxic effects among different therapies. Subgroup analyses based on positive lymph node or resection margin were also performed. RESULTS Twelve eligible articles were included. Gemcitabine improved 5-year survival (HR 2.12, 95% CI, confidence interval 1.23-4.02, P = 0.01), whereas fluorouracil (HR 1.61, 95% CI 0.74-3.67) and CRT (HR 1.55, 95% CI 0.82-3.32) provided a poorer survival outcome compared with gemcitabine after 1 year. Similarly, for 5-year survival rates, although differing, CRT did not provide a significant improvement in survival (HR 0.46, 95% CI 0.20-0.97) compared with gemcitabine. Fluorouracil did not appear to provide benefit over gemcitabine (HR 1.56, 95% CI 0.77-3.35). CRT was ranked highest for toxic effects including haematological (OR 5.45, 95% CI 0.01-483.85) and nonhaematological (OR 5.77, 95% CI 0.01-3807.40). CONCLUSIONS Chemotherapy with gemcitabine is the optimum adjuvant treatment with a balanced benefit-toxicity ratio for resected biliary tract cancer. Chemoradiation was more likely to cause toxic effects.
Collapse
Affiliation(s)
- G-Q Zhu
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Sonmez OU, Arslan UY, Esbah O, Helvaci K, Turker I, Uyeturk U, Budakoglu B, Bal O, Oksuzoglu B. Effects of comorbidities and functional living activities on survival in geriatric breast cancer patients. Contemp Oncol (Pozn) 2014; 18:204-10. [PMID: 25520582 PMCID: PMC4268993 DOI: 10.5114/wo.2014.42252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY We evaluated the possible effects of comorbid diseases and functional capacity on the survival of elderly female patients with breast cancer. MATERIAL AND METHODS The study included 159 breast cancer patients aged 65 years or older. Functional status of the patients was evaluated using Katz's index of activities of daily living (ADL) and Lawton and Brody's Instrumental ADL (IADL) scale. RESULTS ADL-based evaluation revealed 121 patients (76.1%) were independent, 34 (21.4%) semi-dependent and 4 (2.5%) dependent whereas IADL-based evaluation showed 69 patients (43.4%) were independent, 67 patients (42.1%) semi-dependent and 23 patients (14.5%) dependent. Among the patients, 69 (43.4%) had one comorbid disease, 62 (39.0%) had two and 26 (16.4%) had three or more. Of the entire cohort, 60.4% received adjuvant chemotherapy. Based on ADL index, overall survival (OS) was significantly better in semi-dependent and independent patients than in dependent patients (p = 0.001). In the upfront non-metastatic patient subgroup, disease-free survival (DFS) was favourable in the independent patients according to ADL index (p = 0.001). Having more than one comorbid disease had an unfavourable effect on OS. In the multiple regression analysis of non-metastatic patients, stage, triple-negative histology and ADL index remained significant in terms of OS (p = 0.008, HR: 3.17, CI: 1.35-7.44; p = 0.027, HR: 2.78, CI: 1.172-6.91; and p = 0.006, HR: 0.29, CI: 0.12-0.70, respectively). CONCLUSIONS In elderly patients with breast cancer, evaluation of daily living activities and comorbid diseases are as important as staging and subclassification of breast cancer in the determination of prognosis and survival.
Collapse
Affiliation(s)
- Ozlem U Sonmez
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ulku Y Arslan
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Onur Esbah
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Kaan Helvaci
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ibrahim Turker
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Ummugul Uyeturk
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Burcin Budakoglu
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Oznur Bal
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Berna Oksuzoglu
- Ankara Dr AY Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| |
Collapse
|
35
|
Basso U, Brunello A, Pogliani C, Monfardini S. Treatment options for early breast cancer in elderly women. Expert Rev Anticancer Ther 2014; 4:197-211. [PMID: 15056050 DOI: 10.1586/14737140.4.2.197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In clinical practice, approximately 50% of new cases of breast cancer occur in women over the age of 65 years, although very few elderly women have been enrolled in the numerous randomized trials conducted so far. Notwithstanding less aggressive biologic features compared with younger patients, breast cancer impacts on mortality of elderly women, especially if not adequately treated. As confirmed by meta-analyses, hormonal therapy is the most effective adjuvant measure for patients with localized disease, whereas the decrease in the benefit of cytotoxic treatment with increased risk of toxicity make the decision on when and how to administer it a major challenge for the medical oncologist. Careful evaluation of biological prognostic factors, performance status and geriatric parameters, such as functional independence, comorbidities and cognitive function of the patient, along with determination of her life expectancy and preferences, represent the relevant information on which the oncologist should ground their decision for integrated treatment with conservative surgery, radiotherapy and hormonochemotherapy in otherwise healthy women, or attenuated or palliative measures for the frail patients, in order to maximize the balance of benefits and toxicities. The aims of this review are to summarize the most relevant concepts for decision making in the clinical practice and discuss the results of recent research concerning the additional needs of elderly women with early breast cancer.
Collapse
Affiliation(s)
- Umberto Basso
- Department of Medical Oncology, Ospedale Busonera, via Gattamelata 64, Azienda Ospedale - Università, 35100 Padova, Italy.
| | | | | | | |
Collapse
|
36
|
Liao WC, Chien KL, Lin YL, Wu MS, Lin JT, Wang HP, Tu YK. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol 2013; 14:1095-1103. [PMID: 24035532 DOI: 10.1016/s1470-2045(13)70388-7] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major adjuvant treatments for pancreatic adenocarcinoma include fluorouracil, gemcitabine, chemoradiation, and chemoradiation plus fluorouracil or gemcitabine. Since the optimum regimen remains inconclusive, we aimed to compare these treatments in terms of overall survival after tumour resection and in terms of grade 3-4 toxic effects with a systematic review and random-effects Bayesian network meta-analysis. METHODS We searched PubMed, trial registries, and related reviews and abstracts for randomised controlled trials comparing the above five treatments with each other or observation alone before April 30, 2013. We estimated relative hazard ratios (HRs) for death and relative odds ratios (ORs) for toxic effects among different therapies by combining HRs for death and survival durations and ORs for toxic effects of included trials. We assessed the effects of prognostic factors on survival benefits of adjuvant therapies with meta-regression. FINDINGS Ten eligible articles reporting nine trials were included. Compared with observation, the HRs for death were 0·62 (95% credible interval 0·42-0·88) for fluorouracil, 0·68 (0·44-1·07) for gemcitabine, 0·91 (0·55-1·46) for chemoradiation, 0·54 (0·15-1·80) for chemoradiation plus fluorouracil, and 0·44 (0·10-1·81) for chemoradiation plus gemcitabine. The proportion of patients with positive lymph nodes was inversely associated with the survival benefit of adjuvant treatments. After adjustment for this factor, fluorouracil (HR 0·65, 0·49-0·84) and gemcitabine (0·59, 0·41-0·83) improved survival compared with observation, whereas chemoradiation resulted in worse survival than fluorouracil (1·69, 1·12-2·54) or gemcitabine (1·86, 1·04-3·23). Chemoradiation plus gemcitabine was ranked the most toxic, with significantly higher haematological toxic effects than second-ranked chemoradiation plus fluorouracil (OR 13·33, 1·01-169·36). INTERPRETATION Chemotherapy with fluorouracil or gemcitabine is the optimum adjuvant treatment for pancreatic adenocarcinoma and reduces mortality after surgery by about a third. Chemoradiation plus chemotherapy is less effective in prolonging survival and is more toxic than chemotherapy. FUNDING None.
Collapse
Affiliation(s)
- Wei-Chih Liao
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Lin Lin
- Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jaw-Town Lin
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
37
|
Jiang H, Lu J, Jiang J, Hu P. Important Role of the Dihydrouracil/Uracil Ratio in Marked Interpatient Variations of Fluoropyrimidine Pharmacokinetics and Pharmacodynamics. J Clin Pharmacol 2013; 44:1260-72. [PMID: 15496644 DOI: 10.1177/0091270004268911] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Dihydropyrimidine dehydrogenase (DPD) deficiency in patients causes severe toxicities in 5-fluorouracil/floxuridine (5-FU/FUDR) treatments. To determine the plasma dihydrouracil/uracil ratio (DUUR) as a potential index for setting 5-FU/FUDR doses, the authors conducted a prospective study on the relationships of the DUUR with 5-FU/FUDR pharmacokinetic and pharmacodynamic parameters. Forty gestational trophoblastic tumor (GTT) patients were treated with 30 mg/kg of 5-FU or prodrug FUDR during a 10-day cycle. The pretreatment DUURs of the patients were determined prior to the treatments, and plasma 5-FU and FUDR concentrations on day 1 of the test cycle were measured to calculate the corresponding pharmacokinetic parameters. The absolute neutrophil count (ANC) and human chorionic gonadotrophins (HCG/beta-HCG) were recorded as the efficacy indexes. The correlation of the DUUR with pharmacokinetic parameters and efficacy indexes was analyzed to look for a relationship between individual doses (in milligrams) and the varied DUUR. Pretreatment DUUR was significantly correlated with the corresponding plasma AUC (r > 0.80, P < .01), the plasma drug clearance (r > 0.78, P < .01), the ANC (r > 0.76, P < 0.01), and the decrease of HCG/beta-HCG levels (r > 0.5, P < 0.01). In addition, the charts for setting 5-FU/FUDR doses were designed for further validation in clinical trials. These findings indicate the important roles of the DUUR in remarkable interpatient variations of fluoropyrimidine pharmacokinetics and pharmacodynamics and propose a better index for setting individual 5-FU/FUDR doses based on interpatient variations in DPD levels.
Collapse
Affiliation(s)
- Hao Jiang
- Clinical Pharmacology Research Center, Peking Union Medical University Hospital, Beijing, China
| | | | | | | |
Collapse
|
38
|
Can we predict chemo-induced hematotoxicity in elderly patients treated with pegylated liposomal doxorubicin? Results of a population-based model derived from the DOGMES phase II trial of the GINECO. J Geriatr Oncol 2013; 4:48-57. [DOI: 10.1016/j.jgo.2012.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 05/31/2012] [Accepted: 06/27/2012] [Indexed: 12/27/2022]
|
39
|
Welch MR, Omuro A, DeAngelis LM. Outcomes of the oldest patients with primary CNS lymphoma treated at Memorial Sloan-Kettering Cancer Center. Neuro Oncol 2012; 14:1304-11. [PMID: 22952196 PMCID: PMC3452344 DOI: 10.1093/neuonc/nos207] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/23/2012] [Indexed: 11/13/2022] Open
Abstract
Up to 20% of all primary CNS lymphoma (PCNLS) patients are aged 80 years or older, yet data are limited on how best to treat this rapidly growing population. Despite demographic pressures and the proven efficacy of methotrexate (MTX)-based regimens, automatic de-escalation of care based on age is standard practice outside of tertiary care centers. We performed a retrospective review of all PCNSL patients aged 80 years or older treated at Memorial Sloan-Kettering Cancer Center from 1993 to 2011. Demographic and clinical variables were evaluated as predictors of survival by multivariate analysis. Twenty-three of 24 patients were treated with chemotherapy (92% with high-dose MTX, typically in combination with vincristine and procarbazine). One patient received ocular radiation alone for disease limited to the eyes. Response to treatment was noted in 62.5% of patients; 9 (37.5%) had refractory disease. Median overall survival was 7.9 months (95% confidence interval [CI]: 5.8-53), and median progression-free survival was 6.5 months (95% CI: 4.4-29.5). Two-year survival rate was 33%; 3-year survival rate was 17%. Three patients lived more than 4 years postdiagnosis. Most patients tolerated therapy well, and despite low baseline creatinine clearance, no significant renal toxicity was noted. Response status and deep brain involvement were identified as the most important predictors of survival. Multidrug regimens containing high-dose MTX are feasible and efficacious among the oldest patients, particularly those who achieve a complete response by their fifth treatment cycle. Aggressive therapy should be offered to select patients irrespective of advanced age.
Collapse
Affiliation(s)
| | | | - Lisa M. DeAngelis
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
40
|
Falandry C, Gilson E, Rudolph KL. Are aging biomarkers clinically relevant in oncogeriatrics? Crit Rev Oncol Hematol 2012; 85:257-65. [PMID: 22948097 DOI: 10.1016/j.critrevonc.2012.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 07/18/2012] [Accepted: 08/07/2012] [Indexed: 12/22/2022] Open
Abstract
Immunosenescence and inflammaging have been depicted for long as age-related heterogeneous blood phenotypic changes ("immunoaging"). Some of them can be reproduced in animal models either by accelerating telomere shortening or by forcing DNA damage response. According to these models, "immunoaging" is the consequence of replicative senescence of hematopoietic stem cells. This increasing knowledge may impact oncogeriatrics in the future since (1) an increasing evidence links hematopoietic and cancer stem cells regulations; (2) immunosenescence may be linked to cancer immunotolerance and the increasing rate of cancer incidence with age; (3) immunoaging has a major consequence during cancer treatment, since it explains increased hematological toxicities observed in the elderly and (4) it favors secondary cancers and mainly hemopathies. For all these reasons, aging biomarkers, among which are telomere length peripheral blood sampling but also analyses of telomere-linked proteins like shelterin complex or DNA-damage markers will probably be clinically relevant in the future.
Collapse
Affiliation(s)
- Claire Falandry
- Geriatrics Unit, Lyon Sud University Hospital, Pierre-Benite, France.
| | | | | |
Collapse
|
41
|
Peyrade F, Gastaud L, Ré D, Pacquelet-Cheli S, Thyss A. Treatment decisions for elderly patients with haematological malignancies: a dilemma. Lancet Oncol 2012; 13:e344-52. [DOI: 10.1016/s1470-2045(12)70234-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
42
|
Crawford J. Adjuvant treatment of older patients with lung cancer. Am Soc Clin Oncol Educ Book 2012:315-9. [PMID: 24451756 DOI: 10.14694/edbook_am.2012.32.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although advances in the molecular biology of lung cancer have rapidly impacted management of patients with advanced stage non-small cell lung cancer (NSCLC), the principal treatment in the adjuvant setting of early stage NSCLC remains platinum-based chemotherapy regimens. The evidence available from clinical trials demonstrates a similar benefit of adjuvant chemotherapy in fit, older patients as well as younger patients. Observational studies suggest that adjuvant chemotherapy for older patients provides comparable survival benefit, along with increased toxicity. The lower use of chemotherapy in the older population also suggests that the selection of appropriate patients remains an important part of the decision process. Carboplatin therapy may be substituted for cisplatin in selected older patients, and different options exist for the second cytotoxic chemotherapy agent. As in all patients, and particularly in this vulnerable population receiving cytotoxic chemotherapy, supportive care is vital. Increasing enrollment of the older population in clinical trials will be important to improve the evidence for our decision-making in the future.
Collapse
|
43
|
Abstract
Cancer incidence and mortality rise exponentially in the elderly. With the aging of the population there is an urgent need to address this issue with evidence-based guidelines. Delayed diagnosis and incomplete workup and treatment are well documented in this population. Incorporation of a geriatric evaluation in oncology practice should be routinely implemented to prevent adverse outcomes. Treatment decisions in the elderly should not be based solely on survival gains but should also take quality of life into consideration. Cancer treatment is safe and effective in the elderly population. Social issues and other comorbidities should be addressed to improve compliance and outcome. Many unanswered questions regarding the optimal management of elderly cancer patients can be addressed only with the new clinical trials. Eliminating age bias among health care providers by providing education will help achieve optimal care for the elderly with cancer.
Collapse
Affiliation(s)
- Deepak Kilari
- Department of Medicine, Hematology/Oncology, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY 14642, USA
| | | |
Collapse
|
44
|
Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, Schreiber FJ, Balducci L. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 2011; 118:3377-86. [PMID: 22072065 DOI: 10.1002/cncr.26646] [Citation(s) in RCA: 730] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tools are lacking to assess the individual risk of severe toxicity from chemotherapy. Such tools would be especially useful for older patients, who vary considerably in terms of health status and functional reserve. METHODS The authors conducted a prospective, multicentric study of patients aged ≥70 years who were starting chemotherapy. Grade 4 hematologic (H) or grade 3/4 nonhematologic (NH) toxicity according to version 3.0 of the Common Terminology Criteria for Adverse Events was defined as severe. Twenty-four parameters were assessed. Toxicity of the regimen (Chemotox) was adjusted using an index to estimate the average per-patient risk of chemotherapy toxicity (the MAX2 index). In total, 562 patients were accrued, and 518 patients were evaluable and were split randomly (2:1 ratio) into a derivation cohort and a validation cohort. RESULTS Severe toxicity was observed in 64% of patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score was constructed along 2 subscores: H toxicity and NH toxicity. Predictors of H toxicity were lymphocytes, aspartate aminotransferase level, Instrumental Activities of Daily Living score, lactate dehydrogenase level, diastolic blood pressure, and Chemotox. The best model included the 4 latter predictors (risk categories: low, 7%; medium-low, 23%; medium-high, 54%; and high, 100%, respectively; P(trend) < .001). Predictors of NH toxicity were hemoglobin, creatinine clearance, albumin, self-rated health, Eastern Cooperative Oncology Group performance, Mini-Mental Status score, Mini-Nutritional Assessment score, and Chemotox. The 4 latter predictors provided the best model (risk categories: 33%, 46%, 67%, and 93%, respectively; P(trend) < .001). The combined risk categories were 50%, 58%, 77%, and 79%, respectively; P(trend) < .001). Bootstrap internal validation and independent sample validation demonstrated stable risk categorization and P(trend) < .001. CONCLUSIONS The CRASH score distinguished several risk levels of severe toxicity. The split score discriminated better than the combined score. To the authors' knowledge, this is the first score systematically integrating both chemotherapy and patient risk for older patients and has a potential for future clinical application.
Collapse
Affiliation(s)
- Martine Extermann
- Senior Adult Oncology Program, Moffitt Cancer Center, University of South Florida, Tampa, Florida 33612, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Fauci JM, Whitworth JM, Schneider KE, Subramaniam A, Zhang B, Frederick PJ, Kilgore LC, Straughn JM. Prognostic significance of the relative dose intensity of chemotherapy in primary treatment of epithelial ovarian cancer. Gynecol Oncol 2011; 122:532-5. [DOI: 10.1016/j.ygyno.2011.05.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/16/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
|
46
|
Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, Klapper S, Hansen K, Ramani R, Lachs M, Wong FL, Tew WP. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011; 29:3457-65. [PMID: 21810685 DOI: 10.1200/jco.2011.34.7625] [Citation(s) in RCA: 1221] [Impact Index Per Article: 93.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity. PATIENTS AND METHODS Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events. RESULTS In total, 500 patients with a mean age of 73 years (range, 65 to 91 years) with stage I to IV lung (29%), GI (27%), gynecologic (17%), breast (11%), genitourinary (10%), or other (6%) cancer joined this prospective study. Grade 3 to 5 toxicity occurred in 53% of the patients (39% grade 3, 12% grade 4, 2% grade 5). A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. A scoring system in which the median risk score was 7 (range, 0 to 19) and risk stratification schema (risk score: percent incidence of grade 3 to 5 toxicity) identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < .001). CONCLUSION A risk stratification schema can establish the risk of chemotherapy toxicity in older adults. Geriatric assessment variables independently predicted the risk of toxicity.
Collapse
Affiliation(s)
- Arti Hurria
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Ladoire S, Rambach L, Quipourt V, Favier L, Ghiringhelli F, Arnould L, Pfitzenmeyer P, Fumoleau P, Coudert B. Feasibility and Safety of Weekly Sequential Epirubicin-Paclitaxel as Adjuvant Treatment for Operable Breast Cancer Patients Older than 70 Years. Clin Breast Cancer 2011; 11:235-40. [DOI: 10.1016/j.clbc.2011.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/19/2010] [Accepted: 12/01/2010] [Indexed: 11/28/2022]
|
48
|
Sullivan SD, Ramsey SD, Blough DK, McDermott CL, Clarke L, McCune JS. Health care use and primary prophylaxis with colony-stimulating factors. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:247-252. [PMID: 21402293 DOI: 10.1016/j.jval.2010.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 08/04/2010] [Accepted: 09/10/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES We examined health care use in conjunction with primary prophylaxis use of colony stimulating factors (CSF) during patients' initial course of chemotherapy. METHODS This retrospective cohort study identified adults aged 25 years and older with a diagnosis of breast, colorectal, or nonsmall cell lung cancer between 2002 and 2005 from the Western Washington Surveillance Epidemiology and End Results Puget Sound registry. We linked these records to health insurance claims from four payers representing 75% of those insured in the state. Claims records were used to determine chemotherapy regimen type, CSF use, febrile neutropenia occurrences, and supportive care. Chemotherapy regimens were categorized as conferring high, intermediate, or low risk of myelosuppression according to the National Comprehensive Cancer Network guidelines. CSF use was described as primary prophylaxis, other, or none. Antibiotics and antifungal and antiviral agents per National Comprehensive Cancer Network guidelines for supportive care for cancer infection were categorized using Healthcare Common Procedure Coding System and National Drug Code assignments. RESULTS Use of CSF as primary prophylaxis is not significantly associated with a reduction in antibiotic use or inpatient or outpatient visits. Primary prophylactic CSF use was associated with less use of antiviral drugs. CONCLUSIONS CSF use is not associated with a reduction in health care use, with the exception of antiviral drug use. Given the expense associated with CSF use, pragmatic trials and additional research are needed to further assess the affects of CSF on health care use.
Collapse
Affiliation(s)
- Sean D Sullivan
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | | | | | | | | | | |
Collapse
|
49
|
Spazzapan S, Crivellari D, Bedard P, Lombardi D, Miolo G, Scalone S, Veronesi A. Therapeutic management of breast cancer in the elderly. Expert Opin Pharmacother 2011; 12:945-60. [DOI: 10.1517/14656566.2011.540570] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
50
|
Aapro M, Bernard-Marty C, Brain E, Batist G, Erdkamp F, Krzemieniecki K, Leonard R, Lluch A, Monfardini S, Ryberg M, Soubeyran P, Wedding U. Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper. Ann Oncol 2011; 22:257-67. [DOI: 10.1093/annonc/mdq609] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|