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Zago E, Galluzzo A, Pradella S, Antonuzzo L, Maggi M, Petrone L, Sparano C. Cabozantinib for different endocrine tumours: killing two birds with one stone. A systematic review of the literature. Endocrine 2024; 83:26-40. [PMID: 37851242 PMCID: PMC10805963 DOI: 10.1007/s12020-023-03526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Cabozantinib is an oral multi-tyrosine kinase inhibitor (TKI) that has been approved in Europe for advanced renal cell carcinoma, hepatocellular carcinoma, locally advanced and metastatic medullary thyroid carcinoma (MTC) and radioiodine-refractory differentiated thyroid cancer. Merkel cell carcinoma (MCC) is a rare and highly aggressive cutaneous malignant neuroendocrine tumour that usually presents in sun-exposed skin areas of immunosuppressed patients. Conflicting data exist about cabozantinib for MCC and this TKI is currently under investigation in several onco-endocrine frameworks. METHODS We herein report a case of an 83-year-old man who was diagnosed with MCC during the treatment of an advanced metastatic MTC. The diagnosis of MCC was established based on clinical, histopathologic evaluation and immunohistochemistry. A systematic review of the literature on cabozantinib use for advanced endocrine and neuroendocrine tumours has been performed. RESULTS The patient was initially treated with surgery and adjuvant radiotherapy. Cabozantinib was therefore started to control both MTC and MCC. After 24 months, no sign of local or metastatic MCC relapse was evidenced. CONCLUSION Promising data on cabozantinib treatment for endocrine and neuroendocrine neoplasms is recently emerging in the literature. In our clinical case, we reported that, besides the good response for the MTC, cabozantinib also seems to effectively control metastatic MCC, along with efficient surgery and adjuvant radiotherapy. Further investigations are needed to determine the efficacy and safety of cabozantinib in MCC patients and in off-label endocrine tumours.
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Affiliation(s)
- Elena Zago
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Antonio Galluzzo
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Department of Experimental & Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Luisa Petrone
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
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Yabuki Y, Hanibuchi M, Takeuchi E, Haku T, Kanematsu T, Nishimura N, Toyoda Y, Mitsuhashi A, Otsuka K, Sato S, Goto H, Yoneda H, Ogino H, Nokihara H, Tsutomu S, Nishioka Y. A multicenter, open-label, phase II trial of pemetrexed plus bevacizumab in elderly patients with previously untreated advanced or recurrent nonsquamous non-small cell lung cancer. Thorac Cancer 2023; 14:3232-3239. [PMID: 37718463 PMCID: PMC10643789 DOI: 10.1111/1759-7714.15115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Although the incidence of lung cancer in elderly individuals has been increasing in recent years, the number of clinical trials designed specifically for elderly patients with advanced non-small cell lung cancer (NSCLC) is still limited. To fulfill this unmet medical need, we conducted a phase II study to elucidate the efficacy of pemetrexed (PEM) plus bevacizumab (Bev) combination chemotherapy in elderly patients with nonsquamous NSCLC. METHODS A total of 29 elderly patients (≥75 years old) with nonsquamous NSCLC were enrolled in this multicenter, open-label, phase II study, and 27 patients were finally analyzed. PEM at 500 mg/m2 on day 1 plus Bev at 15 mg/kg on day 1 were administered triweekly. The primary endpoint was the investigator-assessed objective response rate. RESULTS The median age at initiating chemotherapy was 80 years old. Almost all patients (92.6%) had adenocarcinoma histology. The median number of cycles administered was 6, and the objective response rate was 40.7%. The median progression-free survival, overall survival and 1-year survival were 8.8 months, 27.2 months and 79%, respectively. The treatment was well-tolerated, and no treatment-related death was observed. CONCLUSION Combination chemotherapy with PEM plus Bev in elderly patients with previously untreated advanced non-squamous NSCLC exhibited favorable antitumor activity and tolerability, suggesting that a combination of PEM plus Bev might be a promising treatment option for this population.
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Affiliation(s)
- Yohei Yabuki
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Masaki Hanibuchi
- Department of Community Medicine for Respirology, Hematology and Metabolism, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Eiji Takeuchi
- Department of Clinical InvestigationNational Hospital Organization Kochi HospitalKochiJapan
| | - Takashi Haku
- Department of Respiratory MedicineTokushima Prefectural Central HospitalTokushimaJapan
| | - Takanori Kanematsu
- Department of Respiratory MedicineJapanese Red Cross Matsuyama HospitalMatsuyamaJapan
| | - Naoki Nishimura
- Department of Pulmonary MedicineSt. Luke's International HospitalTokyoJapan
| | - Yuko Toyoda
- Department of Internal MedicineJapanese Red Cross Kochi HospitalKochiJapan
| | - Atsushi Mitsuhashi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Kenji Otsuka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Seidai Sato
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Hiroto Yoneda
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Hiroshi Nokihara
- Department of Respiratory MedicineCenter Hospital of the National Center for Global Health and MedicineTokyoJapan
| | - Shinohara Tsutomu
- Department of Community Medicine for Respirology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
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Matsumoto K, Tamiya A, Inagaki Y, Taniguchi Y, Matsuda Y, Kawachi H, Tamiya M, Tanizaki S, Uchida J, Ueno K, Yanase T, Suzuki H, Atagi S. Efficacy and safety of ramucirumab plus docetaxel in older patients with advanced non-small cell lung cancer: A multicenter retrospective cohort study. J Geriatr Oncol 2022; 13:207-213. [PMID: 34602370 DOI: 10.1016/j.jgo.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Ramucirumab (RAM) plus Docetaxel (DOC) is one of the standard treatments after first-line treatment failure in patients with advanced non-small cell lung cancer (NSCLC). However, little is known about the efficacy and safety of RAM plus DOC in older patients. We aimed to clarify these and elucidate the prognostic factors. MATERIALS AND METHODS In this multicenter retrospective study, conducted at four medical facilities in Japan, we evaluated the efficacy and safety data for two groups (<65 and ≥ 65 years). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and log-rank test. Multivariate analysis was performed to reveal the prognostic factors for better PFS and OS. Patient characteristics and adverse events (AEs) in both groups were compared using the Mann-Whitney's U and Fisher's exact tests for categorical variables. RESULTS A total of 237 patients were included, of whom 43% (n = 103), and 57% (n = 134) were aged <65, and ≥ 65 years. Median OS was 12.2 (95% CI: 9.4-15.0), and 14.8 months (95% CI: 10.8-18.8), respectively, and there were no significant differences between the groups (p = 0.534). Multivariate analysis identified DOC dose reduction (none vs performed, HR: 2.66, 95% CI: 1.62-4.35, p < 0.001) as an independent prognostic factor for OS in older patients, and a similar result was shown for the PFS. Grade ≥ 3 all AEs were identified in 42.7% and 56.7% of younger and older patients, respectively, and there was a significant difference between the groups (p = 0.033); however, the difference between the groups disappeared with primary DOC dose reduction (p = 0.526). CONCLUSION The efficacy of RAM plus DOC administration in older, pretreated patients with advanced NSCLC was comparable to those of younger patients, whereas RAM plus DOC should be cautiously administered to older patients because of severe toxicity. Moreover, appropriate DOC dose reduction may be recommended for increased survival benefit and safety in such patients.
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Affiliation(s)
- Kinnosuke Matsumoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan.
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan
| | - Yuji Inagaki
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan
| | - Yoshinobu Matsuda
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan
| | - Hayato Kawachi
- Department of Respiratory Medicine, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka City, Osaka 541-8567, Japan
| | - Motohiro Tamiya
- Department of Respiratory Medicine, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka City, Osaka 541-8567, Japan
| | - Satoshi Tanizaki
- Department of Respiratory Medicine, Osaka General Medical Center, 3-1-56 Mandai Higashi, Sumiyoshi-Ku, Osaka City, Osaka 558-8558, Japan
| | - Junji Uchida
- Department of Respiratory Medicine, Osaka General Medical Center, 3-1-56 Mandai Higashi, Sumiyoshi-Ku, Osaka City, Osaka 558-8558, Japan
| | - Kiyonobu Ueno
- Department of Respiratory Medicine, Osaka General Medical Center, 3-1-56 Mandai Higashi, Sumiyoshi-Ku, Osaka City, Osaka 558-8558, Japan
| | - Takafumi Yanase
- Department of Respiratory Medicine, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, 3-7-1 Habikino, Habikino City, Osaka 583-8588, Japan
| | - Hidekazu Suzuki
- Department of Respiratory Medicine, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, 3-7-1 Habikino, Habikino City, Osaka 583-8588, Japan
| | - Shinji Atagi
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan
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Roy S, Pan Z, Pal S. A Fokker-Planck feedback control framework for optimal personalized therapies in colon cancer-induced angiogenesis. J Math Biol 2022; 84:23. [PMID: 35212794 PMCID: PMC8903165 DOI: 10.1007/s00285-022-01725-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/13/2021] [Accepted: 01/30/2022] [Indexed: 02/01/2023]
Abstract
In this paper, a new framework for obtaining personalized optimal treatment strategies in colon cancer-induced angiogenesis is presented. The dynamics of colon cancer is given by a Itó stochastic process, which helps in modeling the randomness present in the system. The stochastic dynamics is then represented by the Fokker-Planck (FP) partial differential equation that governs the evolution of the associated probability density function. The optimal therapies are obtained using a three step procedure. First, a finite dimensional FP-constrained optimization problem is formulated that takes input individual noisy patient data, and is solved to obtain the unknown parameters corresponding to the individual tumor characteristics. Next, a sensitivity analysis of the optimal parameter set is used to determine the parameters to be controlled, thus, helping in assessing the types of treatment therapies. Finally, a feedback FP control problem is solved to determine the optimal combination therapies. Numerical results with the combination drug, comprising of Bevacizumab and Capecitabine, demonstrate the efficiency of the proposed framework.
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Affiliation(s)
- Souvik Roy
- Department of Mathematics, The University of Texas at Arlington, Arlington, TX, 76019-0407, USA.
| | - Zui Pan
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX, 76019-0407, USA
| | - Suvra Pal
- Department of Mathematics, The University of Texas at Arlington, Arlington, TX, 76019-0407, USA
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Norris RP, Dew R, Sharp L, Greystoke A, Rice S, Johnell K, Todd A. Are there socio-economic inequalities in utilization of predictive biomarker tests and biological and precision therapies for cancer? A systematic review and meta-analysis. BMC Med 2020; 18:282. [PMID: 33092592 PMCID: PMC7583194 DOI: 10.1186/s12916-020-01753-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Novel biological and precision therapies and their associated predictive biomarker tests offer opportunities for increased tumor response, reduced adverse effects, and improved survival. This systematic review determined if there are socio-economic inequalities in utilization of predictive biomarker tests and/or biological and precision cancer therapies. METHODS MEDLINE, Embase, Scopus, CINAHL, Web of Science, PubMed, and PsycINFO were searched for peer-reviewed studies, published in English between January 1998 and December 2019. Observational studies reporting utilization data for predictive biomarker tests and/or cancer biological and precision therapies by a measure of socio-economic status (SES) were eligible. Data was extracted from eligible studies. A modified ISPOR checklist for retrospective database studies was used to assess study quality. Meta-analyses were undertaken using a random-effects model, with sub-group analyses by cancer site and drug class. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed for each study. Pooled utilization ORs for low versus high socio-economic groups were calculated for test and therapy receipt. RESULTS Among 10,722 citations screened, 62 papers (58 studies; 8 test utilization studies, 37 therapy utilization studies, 3 studies on testing and therapy, 10 studies without denominator populations or which only reported mean socio-economic status) met the inclusion criteria. Studies reported on 7 cancers, 5 predictive biomarkers tests, and 11 biological and precision therapies. Thirty-eight studies (including 1,036,125 patients) were eligible for inclusion in meta-analyses. Low socio-economic status was associated with modestly lower predictive biomarker test utilization (OR 0.86, 95% CI 0.71-1.05; 10 studies) and significantly lower biological and precision therapy utilization (OR 0.83, 95% CI 0.75-0.91; 30 studies). Associations with therapy utilization were stronger in lung cancer (OR 0.71, 95% CI 0.51-1.00; 6 studies), than breast cancer (OR 0.93, 95% CI 0.78-1.10; 8 studies). The mean study quality score was 6.9/10. CONCLUSIONS These novel results indicate that there are socio-economic inequalities in predictive biomarker tests and biological and precision therapy utilization. This requires further investigation to prevent differences in outcomes due to inequalities in treatment with biological and precision therapies.
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Affiliation(s)
- Ruth P. Norris
- School of Pharmacy, Newcastle University, King George VI Building, King’s Road, Newcastle-upon-Tyne, NE1 7RU UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | - Rosie Dew
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | | | - Stephen Rice
- Health Economics Group and Evidence Synthesis Team, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Adam Todd
- School of Pharmacy, Newcastle University, King George VI Building, King’s Road, Newcastle-upon-Tyne, NE1 7RU UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
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6
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Dale W, Mohile SG. Lessons Learned from Arti-Collaborating to Improve Care: the Past, Present, and Future of the Cancer and Aging Research Group. J Am Geriatr Soc 2020; 67:879-883. [PMID: 31034593 DOI: 10.1111/jgs.15935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 11/26/2022]
Abstract
Dr Arti Hurria, who died tragically in November 2018, was a driving force in the growing field of geriatric oncology. She led the field through her commitment to her goals, collaboration with her colleagues, and the creation of the Cancer and Aging Research Group (CARG). As two of her closest colleagues, we are carrying her work forward with our colleagues through an infrastructure grant we led with Arti from the National Institute on Aging (R21/33; CARinG). This grant will provide a national structure for continuing to build the field through research, mentorship, and dissemination. We miss our friend dearly but are committed to carrying her legacy forward through CARG. J Am Geriatr Soc 67:879-883, 2019.
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Affiliation(s)
- William Dale
- Department of Supportive Care Medicine, Center for Cancer and Aging, City of Hope National Medical Center, Duarte, California
| | - Supriya G Mohile
- Geriatric Oncology Research Program, Cancer Care Delivery Research, University of Rochester Cancer Cancer (URCC) NCI Community Oncology Research Program (NCORP) Research Base, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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Feliu J, Heredia-Soto V, Gironés R, Jiménez-Munarriz B, Saldaña J, Guillén-Ponce C, Molina-Garrido MJ. Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients. Clin Transl Oncol 2019; 22:457-467. [PMID: 31240462 DOI: 10.1007/s12094-019-02167-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/16/2019] [Indexed: 12/22/2022]
Abstract
The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, so cancer treatment in the older patient remains a therapeutic challenge. The physiological changes associated with aging increase the risk of developing a serious toxicity induced by chemotherapy treatment, as well as other undesirable consequences as hospitalizations, dependence and non-compliance with treatment, that can negatively affect survival, quality of life and treatment efficacy. The use of hematopoietic growth factors and other active supportive interventions in the elderly can help prevent and/or alleviate these toxicities. However, we have little data on the efficacy and tolerance of support treatments in the older patient. The objective of this work is to review the most frequent toxicities of oncological treatments in the elderly and their management.
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Affiliation(s)
- J Feliu
- Medical Oncology Department, H. Universitario La Paz, CIBERONC, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - V Heredia-Soto
- Medical Oncology Department, H. Universitario La Paz, CIBERONC, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - R Gironés
- Medical Oncology Department, H. Lluís Alcanyís. Xàtiva, Valencia, Spain
| | - B Jiménez-Munarriz
- Medical Oncology Department, H. Universitario Clara Campal, Madrid, Spain
| | - J Saldaña
- Medical Oncology Department, Instituto Catalán de Oncología, Hospitalet, Barcelona, Spain
| | - C Guillén-Ponce
- Medical Oncology Department, H. Universitario Ramón Y Cajal, Madrid, Spain
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Gouverneur A, Bezin J, Jové J, Bosco-Lévy P, Fourrier-Réglat A, Noize P. Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life. J Am Geriatr Soc 2019; 67:913-919. [PMID: 30840323 DOI: 10.1111/jgs.15858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Metastatic colorectal cancer (mCRC) is increasingly treated with targeted therapies, but little is known about real-life mCRC treatment in older adults. The aims were to describe the real-life first-line treatment modalities in older adult mCRC patients, to identify factors associated with treatment modalities, and to evaluate survival with regard to treatment modalities. PATIENTS AND METHODS A cohort of mCRC patients aged 65 years and older at diagnosis was identified between 2009 and 2013 using French national healthcare insurance system claims data. Treatment modalities were: treatment with one or more anticancer medication vs best supportive care and, among treated patients, treatment with targeted therapy vs conventional chemotherapy alone. Multivariate logistic regression was used to identify factors associated with treatment by anticancer medication and by targeted therapy. Cox proportional hazards models were used to assess the independent effect of treatment modalities on overall survival while adjusting for baseline covariates identified with logistic regression. RESULTS A total of 503 patients were included with a median age of 78 years (54% were men). Of these, 299 (59%) were treated with anticancer medications. Among treated patients, 131 (44%) received targeted therapy. In multivariate analysis, age 75 years or older, renal failure, malnutrition, and five or more concomitant medications were associated with a lower likelihood of treatment with anticancer medications. Among treated patients, age 75 years or older, history of cancer, lymph node metastases, and a single metastatic site were associated with a lower likelihood of treatment with targeted therapy. Multivariate Cox proportional hazards models found that treatment with any anticancer medication tended to be associated with a lower risk of death; treatment with targeted therapy was not significantly associated. CONCLUSION A more appropriate prescription of anticancer medications in the older adult will require the definition of more explicit criteria to avoid undertreatment. The real benefit of targeted therapies vs conventional chemotherapy alone needs to be confirmed in this population. J Am Geriatr Soc 67:913-919, 2019.
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Affiliation(s)
- Amandine Gouverneur
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,Pôle de Santé publique, Service de Pharmacologie médicale, CHU de Bordeaux, Bordeaux, France
| | - Julien Bezin
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France
| | | | - Annie Fourrier-Réglat
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,Pôle de Santé publique, Service de Pharmacologie médicale, CHU de Bordeaux, Bordeaux, France.,Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France
| | - Pernelle Noize
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,Pôle de Santé publique, Service de Pharmacologie médicale, CHU de Bordeaux, Bordeaux, France.,Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France
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Couderc AL, Boulahssass R, Nouguerède E, Gobin N, Guérin O, Villani P, Barlesi F, Paillaud E. Functional status in a geriatric oncology setting: A review. J Geriatr Oncol 2019; 10:884-894. [PMID: 30824222 DOI: 10.1016/j.jgo.2019.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/07/2019] [Accepted: 02/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA), is used in older patients with cancer to identify frailties, which can interfere with specialized treatment, and to help with therapeutic care. Functional Status (FS) is a domain of CGA in which Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) are evaluation tools. OBJECTIVE Our study reviewed the data available on the most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival (OS), toxicity, treatment feasibility or decision and postoperative complications. DESIGN This review was based on a systematic search of the MEDLINE® database for articles published in English and French between January 1, 2010, and December 31, 2017. In the final analysis, 40 out of 4061 studies were included. RESULTS The most common ADL and IADL scales used are the Katz ADL (KL-ADL) in 25 studies and the Lawton IADL (IADL8) in 22 studies. FS is predictive of OS in 11 out of 24 studies, chemotoxicity in 2 out of 7 studies, treatment feasibility in 2 out of 5 studies, treatment decisions in 2 out of 3 studies, and postoperative complications in 4 out of 6 studies. CONCLUSION FS is of prognostic value in a geriatric oncology setting despite heterogeneous methodology and inclusion criteria, in the studies included. Additional research is needed to explore more precisely the prognostic value of FS in overall survival, toxicity, treatment feasibility or decision and postoperative complications, in older cancer patients.
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Affiliation(s)
- Anne-Laure Couderc
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Coordination Unit for Geriatric Oncology (UCOG), PACA West, France.
| | - Rabia Boulahssass
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France
| | - Emilie Nouguerède
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Nirvina Gobin
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Olivier Guérin
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France; Nice Sophia-Antipolis University, Nice, France
| | - Patrick Villani
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Aix-Marseille University, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, Marseille, France; Division of Multidisciplinary Oncology and Therapeutic Innovations, North Hospital, AP-HM, Marseille, France
| | - Elena Paillaud
- Department of Geriatrics, Geriatric Oncology Unit, APHP, Hospital European Georges Pompidou, Paris, France; Clinical Epidemiology and Ageing Unit, EA, 7376, Universite' Paris-Est, Creteil, France
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Li D, McCall LM, Hahn OM, Hudis CA, Cohen HJ, Muss HB, Jatoi A, Lafky JM, Ballman KV, Winer EP, Tripathy D, Schneider B, Barry W, Dickler MN, Hurria A. Identification of risk factors for toxicity in patients with hormone receptor-positive advanced breast cancer treated with bevacizumab plus letrozole: a CALGB 40503 (alliance) correlative study. Breast Cancer Res Treat 2018; 171:325-34. [PMID: 29789969 DOI: 10.1007/s10549-018-4828-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND In hormone receptor-positive advanced breast cancer, a progression-free survival benefit was reported with addition of bevacizumab to first-line letrozole. However, increased toxicity was observed. We hypothesized that functional age measures could be used to identify patients at risk for toxicity while receiving letrozole plus bevacizumab for hormone receptor-positive advanced breast cancer. METHODS CALGB 40503 was a phase III trial that enrolled patients with hormone receptor-positive advanced breast cancer randomized to letrozole with or without bevacizumab. Patients randomized to bevacizumab were approached to complete a validated assessment tool evaluating physical function, comorbidity, cognition, psychological state, social support, and nutritional status. The relationship between pretreatment assessment measures and the incidence of grade ≥ 3 (National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.0) adverse events was determined. RESULTS One hundred thirteen (58%) of 195 patients treated with letrozole plus bevacizumab completed the pretreatment assessment questionnaire. One patient was excluded due to missing adverse event data. The median age of patients was 56. Frequently reported grade ≥ 3 adverse events were hypertension (26%), pain (20%), and proteinuria (7%). Two hemorrhagic events (one grade 5) and 1 thrombosis event occurred. Age ≥ 65 years (p < 0.01), decreased vision (p = 0.04), and poorer pretreatment physical function measures (p < 0.05) were found on univariate analysis to be significantly associated with increased incidence of grade ≥ 3 adverse events. Upon multivariate analysis, age ≥ 65 years (p = 0.01) and decreased vision (p = 0.04) remained significant. Univariable and multivariable logistic regression models demonstrated associations between age, vision, the ability to walk up flights of stairs, and grade ≥ 3 adverse events. CONCLUSIONS Age (≥ 65 years), decreased vision, and impairments in physical function correlated with increased incidence of toxicity in patients receiving first-line letrozole plus bevacizumab. When evaluating therapy likely to increase toxicity, functional assessment measures can identify patients at increased risk for side effects who may benefit from closer monitoring.
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Olsen JJ, Pohl SÖG, Deshmukh A, Visweswaran M, Ward NC, Arfuso F, Agostino M, Dharmarajan A. The Role of Wnt Signalling in Angiogenesis. Clin Biochem Rev 2017; 38:131-142. [PMID: 29332977 PMCID: PMC5759160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Angiogenesis is a normal biological process wherein new blood vessels form from the growth of pre-existing blood vessels. Preventing angiogenesis in solid tumours by targeting pro-angiogenic factors including vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1), basic fibroblast growth factor (bFGF), hepatocyte growth factor, and platelet-derived growth factor (PDGF) is currently under investigation for cancer treatment. Concurrently targeting the cell signalling pathways involved in the transcriptional and post-translational regulation of these factors may provide positive therapeutic results. One such pathway is the Wnt signalling pathway. Wnt was first discovered in mice infected with mouse mammary tumour virus, and has been crucial in improving our understanding of oncogenesis and development. In this review, we summarise molecular and cellular aspects of the importance of Wnt signalling to angiogenesis, including β-catenin-dependent mechanisms of angiogenic promotion, as well as the study of Wnt antagonists, such as the secreted frizzled-related protein family (SFRPs) which have been shown to inhibit angiogenesis. The growing understanding of the underlying complexity of the biochemical pathways mediating angiogenesis is critical to the identification of new molecular targets for therapeutic applications.
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Affiliation(s)
- Jun Jun Olsen
- The School of Human Sciences, The University of Western Australia, Nedlands, WA
| | - Sebastian Öther-Gee Pohl
- Stem Cell and Cancer Biology Laboratory, School of Biomedical Sciences, Curtin Health Innovation Research Institute, Bentley, WA
| | - Abhijeet Deshmukh
- Stem Cell and Cancer Biology Laboratory, School of Biomedical Sciences, Curtin Health Innovation Research Institute, Bentley, WA
| | - Malini Visweswaran
- Stem Cell and Cancer Biology Laboratory, School of Biomedical Sciences, Curtin Health Innovation Research Institute, Bentley, WA
| | - Natalie C Ward
- School of Biomedical Sciences & Curtin Health Innovation Research Institute, Curtin University, Bentley, WA
- Medical School, University of Western Australia, Crawley, WA
| | - Frank Arfuso
- Stem Cell and Cancer Biology Laboratory, School of Biomedical Sciences, Curtin Health Innovation Research Institute, Bentley, WA
| | - Mark Agostino
- Stem Cell and Cancer Biology Laboratory, School of Biomedical Sciences, Curtin Health Innovation Research Institute, Bentley, WA
- Curtin Institute for Computation, Curtin University, Bentley, WA, Australia
| | - Arun Dharmarajan
- Stem Cell and Cancer Biology Laboratory, School of Biomedical Sciences, Curtin Health Innovation Research Institute, Bentley, WA
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Soto-Perez-de-Celis E, de Glas NA, Hsu T, Kanesvaran R, Steer C, Navarrete-Reyes AP, Battisti NML, Chavarri-Guerra Y, O’Donovan A, Avila-Funes JA, Hurria A. Global geriatric oncology: Achievements and challenges. J Geriatr Oncol 2017. [DOI: 10.1016/j.jgo.2017.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Langer CJ, Socinski MA, Patel JD, Sandler AB, Schiller JH, Leon L, Hazard SJ, Ramalingam SS. Isolating the Role of Bevacizumab in Elderly Patients With Previously Untreated Nonsquamous Non-Small Cell Lung Cancer: Secondary Analyses of the ECOG 4599 and PointBreak Trials. Am J Clin Oncol 2016; 39:441-7. [PMID: 25628268 DOI: 10.1097/COC.0000000000000163] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Patient-level data from 2 phase III studies in patients with previously untreated, advanced-stage, nonsquamous non–small cell lung cancer (NSCLC) were pooled to examine outcomes with bevacizumab and chemotherapy based on age.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Socinski MA, Chaft JE, Levy B, Riely GJ, Langer CJ, Perez-Soler R, Middleton DL, Gracie-King L, Healy LM. The Use of Antiangiogenic Agents for Lung Cancer in Elderly Patients: An Expert Panel Discussion Synopsis. Clin Lung Cancer 2017; 18:255-258. [PMID: 28188100 DOI: 10.1016/j.cllc.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Mark A Socinski
- University of Pittsburgh, UPMC Cancer Center, Pittsburgh, PA.
| | - Jamie E Chaft
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Benjamin Levy
- Mount Sinai Hospital, Mount Sinai Health System, New York, NY
| | - Gregory J Riely
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Corey J Langer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Roman Perez-Soler
- Montefiore Medical Center, Albert Einstein College of Medicine, Albert Einstein Cancer Center, Bronx, NY
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Abstract
Ovarian cancer is the seventh most common cancer in women worldwide and accounts for nearly 4% of all new cases of cancer in women. Almost half of all patients with ovarian cancer are over the age of 65 at diagnosis, and over 70% of deaths from ovarian cancer occur in this same age group. As the population ages, the number of older women with ovarian cancer is increasing. Compared to younger women, older women with ovarian cancer receive less surgery and chemotherapy, develop worse toxicity, and have poorer outcomes. They are also significantly under-represented in clinical trials and thus application of standard treatment regimens can be challenging. Performance status alone has been shown to be an inadequate tool to predict toxicity of older patients from chemotherapy. Use of formal geriatric assessment tools is a promising direction for stratifying older patients on trials. Elderly-specific trials, adjustments to the eligibility criteria, modified treatment regimens, and interventions to decrease morbidities in the vulnerable older population should be encouraged.
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Kozuki T, Nogami N, Kitajima H, Iwasawa S, Sakaida E, Takiguchi Y, Ikeda S, Yoshida M, Kato T, Miyamoto S, Sakamaki K, Shinkai T, Watanabe K. Feasibility study of first-line chemotherapy using Pemetrexed and Bevacizumab for advanced or recurrent nonsquamous non-small cell lung cancer in elderly patients: TORG1015. BMC Cancer 2016; 16:306. [PMID: 27177035 PMCID: PMC4866483 DOI: 10.1186/s12885-016-2338-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The addition of bevacizumab to cytotoxic agents prolongs survival in patients with nonsquamous non-small cell lung cancer (NSCLC). To date, there is no evidence to suggest that treatment with a cytotoxic agent plus bevacizumab is more effective than a cytotoxic agent alone for nonsquamous NSCLC in elderly patients. We conducted a feasibility study of pemetrexed plus bevacizumab as a first-line treatment for advanced or recurrent nonsquamous NSCLC in elderly patients. METHODS Major eligibility and exclusion criteria included: chemotherapy-naive status; non-fitness for bolus combination chemotherapy; stage III/IV or relapsed nonsquamous NSCLC; age ≥70; performance status 0-1; absence of brain metastasis; and no history of hemoptysis and thoracic irradiation. Pemetrexed (500 mg/m(2)) and bevacizumab (15 mg/kg) were administered intravenously on day 1, and repeated every 3 weeks thereafter. The primary endpoint was safety, and the secondary endpoints were objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and the percentage of patients who completed ≥3 cycles. RESULTS From October 2010 to April 2012, a total of 12 patients were enrolled. No dose-limiting toxicity or treatment-related deaths were observed. Three patients achieved PR, and the ORR was 25 %. The median PFS and OS were 5.4 months (95 % CI 1.1-8.8 months) and 13.6 months (95 % CI 5.3-15.6 months), respectively. Seven of 12 patients (58 %) received ≥3 cycles. CONCLUSIONS Pemetrexed plus bevacizumab in the treatment of elderly patients with nonsquamous NSCLC was well tolerated and shows promise as first-line treatment. TRIAL REGISTRATION UMIN Clinical Trial Registry; UMIN000004263 . Registered on 25 September, 2010.
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Affiliation(s)
- Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, 160 Kou Minamiumemoto, Matsuyama, Ehime, 791-0280, Japan.
| | - Naoyuki Nogami
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, 160 Kou Minamiumemoto, Matsuyama, Ehime, 791-0280, Japan
| | - Hiromoto Kitajima
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, 160 Kou Minamiumemoto, Matsuyama, Ehime, 791-0280, Japan
| | - Shunichiro Iwasawa
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Emiko Sakaida
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Masahiro Yoshida
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Terufumi Kato
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Shingo Miyamoto
- Department of Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Tetsu Shinkai
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, 160 Kou Minamiumemoto, Matsuyama, Ehime, 791-0280, Japan
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Abstract
Epithelial ovarian cancer is primarily a disease of older women. Advanced age is risk factor for decreased survival. Optimal surgery and the safe and effective administration of chemotherapy are essential for prolonged progression-free and overall survival (OS). In this article, the available regimens in both the primary treatment and relapsed setting are reviewed.
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Affiliation(s)
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 11725, USA
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Bossé D, Vickers M, Lemay F, Beaudoin A. Palliative chemotherapy for patients 70 years of age and older with metastatic colorectal cancer: a single-centre experience. ACTA ACUST UNITED AC 2015; 22:e349-56. [PMID: 26628875 DOI: 10.3747/co.22.2337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Metastatic colorectal cancer (mcrc) commonly affects elderly people, an understudied subset of patients. We analyzed the survival impact of the first and subsequent lines of chemotherapy in eligible non-trial patients 70 years of age and older with mcrc treated between 2004 and 2012. METHODS This single-centre retrospective analysis estimated overall survival (os) and progression-free survival (pfs) using the Kaplan-Meier method. Multivariate analysis was used to adjust for age, sex, Eastern Cooperative Oncology Group performance status, score on the Charlson comorbidity index, dependency in activities of daily living, and exposure to 1 or more chemotherapy doublets, capecitabine alone, or best supportive care (bsc). RESULTS Of 109 patients identified, 29 elected bsc, and 80 received chemotherapy. In multivariate analysis, age was not associated with os [hazard ratio (hr): 0.99; 95% confidence interval (ci): 0.92 to 1.05], but a performance status of 2 or higher was associated with a decreased likelihood of survival (hr: 3.12; 95% ci: 1.87 to 5.76), and exposure to 1 or more doublets was associated with improved survival (hr: 0.33; 95% ci: 0.17 to 0.66). In univariate analysis, a trend toward improved os was observed for first-line doublet chemotherapy compared with capecitabine (hr: 0.66; 95% ci: 0.41 to 1.07), and pfs was superior (hr: 0.46; 95% ci: 0.26 to 0.84). Compared with exposure to 1 doublet, exposure to the 3 potential cytotoxic chemotherapies was not associated with improved os (hr: 0.77; 95% ci: 0.41 to 1.43). The incidence of neutropenia with first-line folfiri was 40%; the incidences of bevacizumab-related arterial and venous thrombosis were both 8%. CONCLUSIONS Exposure to 1 or more doublet chemotherapies for mcrc was associated with better outcomes in non-trial patients 70 years of age and older. Elderly patients treated with palliative chemotherapy and bevacizumab should be monitored carefully for arterial and venous thrombotic events.
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Affiliation(s)
- D Bossé
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC
| | - M Vickers
- Ottawa Regional Cancer Centre, Ottawa, ON
| | - F Lemay
- Gastroenterology Division, Department of Medicine, Centre hospitalier universitaire de Sherbrooke and Centre de recherche clinique Étienne-Le Bel, Sherbrooke, QC
| | - A Beaudoin
- Gastroenterology Division, Department of Medicine, Centre hospitalier universitaire de Sherbrooke and Centre de recherche clinique Étienne-Le Bel, Sherbrooke, QC
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Grapsa D, Syrigos K, Saif MW. Bevacizumab in combination with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy for first-line and maintenance treatment of metastatic colorectal cancer. Expert Rev Anticancer Ther 2015; 15:1267-81. [PMID: 26506906 DOI: 10.1586/14737140.2015.1102063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite a slight decrease in mortality rates, recent advances in screening methods, diagnosis and overall improved therapeutic options, colorectal cancer (CRC) remains among the leading causes of cancer-related death worldwide. The major cause is the mortality related to metastatic status of CRC. Increasing clinical evidence derived from randomized trials strongly suggests that the efficacy of standard cytotoxic agents, including various combinations of 5-fluoouracil (5-FU)/leucovorin (LV), capecitabine, irinotecan and oxaliplatin, may be significantly augmented with concomitant administration of molecular agents targeting the vascular endothelial growth factor (VEGF) signaling pathways, such as bevacizumab. Herein, we critically discuss the current data on the efficacy and safety profile of bevacizumab in combination with fluoropyrimidine-based chemotherapy for first-line and maintenance treatment of metastatic CRC and briefly comment on existing controversies and future perspectives.
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Affiliation(s)
- Dimitra Grapsa
- a Oncology Unit, 3rd Department of Medicine, "Sotiria" General Hospital , Athens University School of Medicine , Athens , Greece
| | - Konstantinos Syrigos
- a Oncology Unit, 3rd Department of Medicine, "Sotiria" General Hospital , Athens University School of Medicine , Athens , Greece
| | - Muhammad Wasif Saif
- a Oncology Unit, 3rd Department of Medicine, "Sotiria" General Hospital , Athens University School of Medicine , Athens , Greece
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Della-Morte D, Riondino S, Ferroni P, Palmirotta R, Pastore D, Lauro D, Guadagni F, Roselli M. Impact of VEGF gene polymorphisms in elderly cancer patients: clinical outcome and toxicity. Pharmacogenomics 2015; 16:61-78. [PMID: 25560471 DOI: 10.2217/pgs.14.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Vascular endothelial growth factors (VEGFs) are the key regulators in angiogenesis and have been shown to play a significant role in the progression and prognosis of angiogenesis-related diseases, such as cancer. VEGF inhibitors are a current pharmacological tumoral strategy. However, despite the strong association between aging and cancer incidence and progression, recent findings suggest impaired angiogenesis accompanied by a reduced expression of VEGF in cells derived from aging subjects. Specific variations of VEGF genes have been demonstrated to be genetic determinants for susceptibility, outcome and therapy response, especially for the solid tumors. Considering the complications present in frail elderly patients, analysis of VEGF genetic polymorphisms in these subjects may further help in tailoring an angiogenic pharmacological strategy, and in improving our ability to better understand prognosis during therapy-related to cancer.
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Affiliation(s)
- David Della-Morte
- Department of Systems Medicine, School of Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133 Rome, Italy
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Sud S, Lai P, Zhang T, Clemons M, Wheatley-price P. Chemotherapy in the oldest old: The feasibility of delivering cytotoxic therapy to patients 80years old and older. J Geriatr Oncol 2015; 6:395-400. [DOI: 10.1016/j.jgo.2015.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/12/2015] [Accepted: 07/23/2015] [Indexed: 12/27/2022]
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Carroll NM, Delate T, Menter A, Hornbrook MC, Kushi L, Aiello Bowles EJ, Loggers ET, Ritzwoller DP. Use of Bevacizumab in Community Settings: Toxicity Profile and Risk of Hospitalization in Patients With Advanced Non-Small-Cell Lung Cancer. J Oncol Pract 2015; 11:356-62. [PMID: 26060223 DOI: 10.1200/jop.2014.002980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Little is known regarding toxicities and hospitalizations in community-based settings for patients with advanced non-small-cell lung cancer (NSCLC) who received commonly prescribed carboplatin-paclitaxel (CP) or carboplatin-paclitaxel-bevacizumab (CPB) chemotherapy. METHODS Patients with stages IIIB-IV NSCLC age ≥ 21 years diagnosed between 2005 and 2010 who received first-line CP or CPB were identified at four health maintenance organizations (N = 1,109). Using patient and tumor characteristics and hospital and ambulatory encounters from automated data in the 180 days after chemotherapy initiation, the association between CP and CPB and toxicities and hospitalizations were evaluated with χ(2) tests and propensity score-adjusted regression models. RESULTS Patients who received CPB were significantly younger and had significantly more bleeding, proteinuria, and GI perforation events (all P < .05). For these patients, the unadjusted odds ratio associated with the likelihood of having a hospitalization was 0.46 (95% CI, 0.32 to 0.67). As shown by multivariable and propensity score-adjusted models, patients who received CPB were less likely to have been hospitalized (odds ratio, 0.48; 95% CI, 0.32 to 0.71) and had fewer total hospitalizations (rate ratio, 0.62; 95% CI, 0.47 to 0.82) and hospital days (rate ratio, 0.53; 95% CI, 0.47 to 0.60) than patients who received CP. CONCLUSION Consistent with earlier randomized clinical trials, significantly more toxicity events were identified in patients treated with CPB. However, both unadjusted and adjusted models showed that patients who received CPB were less likely than patients who received CP to experience a hospital-related event after the initiation of chemotherapy. Findings here confirm the need for adherence to clinical recommendations for judicious use of CPB, but provide reassurance regarding the relative risk for hospitalizations.
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Affiliation(s)
- Nikki M Carroll
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Thomas Delate
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alex Menter
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark C Hornbrook
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lawrence Kushi
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Erin J Aiello Bowles
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth T Loggers
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Debra P Ritzwoller
- Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Northern California, Oakland, CA; The Group Health Research Institute; and Fred Hutchinson Cancer Research Center, Seattle, WA
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Tew WP, Fleming GF. Treatment of ovarian cancer in the older woman. Gynecol Oncol 2015; 136:136-42. [DOI: 10.1016/j.ygyno.2014.10.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 01/05/2023]
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Metges JP, Lebot MA, Faroux R, Riaud F, Gamelin E, Capitain O, Guérin Meyer V, Leynia P, Douillard JY, Senellart H, Rochard S, Louvigné C, Campion L, Dupuis O, Grollier C, Achour NA, Person B, Raoul JL, Boucher E, Bertrand C, Ramée JF, Guivarch L, Etienne PL, Roussel S, Desclos H, Julien MN, Labarre MI, Klein V, Bessard R, Stampfli C, Royet F, Faycal J, Gouva S, Le Bihan G, Couturier M, Gourlaouen A, Bertholom C, Porneuf M, Jobard E, Peguet E, Grasset D, Bouret JF, Bicheler V, Ulvoas A, Miglianico L, Chouzenoux C, Deguiral P, Derenne L, Martin D, Langlet PM, Bodin C, Rossi V, Barré S, Cojocarasu O, Naveau Ploux C, Vidal AM, Cumin I, Egreteau J, Brouard A, Matysiak Budnik T, Thomaré P, Le Bris Michel AS, Piriou G, Largeau R, Elhannani C, Crespeau E, Suberville F, Bourgeois H, Riche C, Lagadec DD, Marhuenda F, Grudé F. Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas ( Observatoire dédié au Cancer Bretagne / Pays de la Loire). ONCOLOGIE 2014; 16:267-276. [PMID: 26190928 PMCID: PMC4496868 DOI: 10.1007/s10269-014-2391-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/07/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer. METHODS/RESULTS A study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks. CONCLUSION Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.
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Affiliation(s)
- J. P. Metges
- />CHU Brest Morvan, Brest, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | | | - R. Faroux
- />CH La Roche-Sur-Yon, La Roche-sur-Yon, France
| | - F. Riaud
- />CH La Roche-Sur-Yon, La Roche-sur-Yon, France
| | - E. Gamelin
- />ICO Paul Papin, Angers, France
- />Fondateur de l’Observatoire dédié au
cancer, Bretagne Pays de la Loire (ex-OMIT B PL), Rennes, France
| | | | | | | | - J. Y. Douillard
- />ICO René Gauducheau, Nantes, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | | | | | | | | | - O. Dupuis
- />Centre Jean Bernard/Clinique Victor-Hugo, Le Mans, France
| | - C. Grollier
- />Centre Jean Bernard/Clinique Victor-Hugo, Le Mans, France
| | | | | | | | | | | | - J. F. Ramée
- />Centre Catherine-de-Sienne, Nantes, France
| | - L. Guivarch
- />Centre Catherine-de-Sienne, Nantes, France
| | - P. L. Etienne
- />Clinique Armoricaine de Radiologie, Saint-Brieuc, France
- />Polyclinique Trégor-Lannion, Lannion, France
| | - S. Roussel
- />Clinique Armoricaine de Radiologie, Saint-Brieuc, France
| | | | | | | | - V. Klein
- />Hôpital Privé Océane/Centre Saint Yves
Vannes, Vannes, France
| | - R. Bessard
- />Hôpital Privé Océane/Centre Saint Yves
Vannes, Vannes, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | | | | | | | - S. Gouva
- />CH Landerneau, Landerneau, France
| | | | | | | | | | | | - E. Jobard
- />CH Saint-Brieuc, Saint-Brieuc, France
| | - E. Peguet
- />CH Saint-Brieuc, Saint-Brieuc, France
| | | | | | | | | | | | | | - P. Deguiral
- />Clinique Mutualiste de l’Estuaire, Saint-Nazaire, France
| | - L. Derenne
- />Clinique Mutualiste de l’Estuaire, Saint-Nazaire, France
| | - D. Martin
- />Polyclinique du Maine/Centre Mallet Proux Laval, Laval, France
| | | | - C. Bodin
- />Polyclinique du Maine/Centre Mallet Proux Laval, Laval, France
| | - V. Rossi
- />CH Haut Anjou Château Gontier, Château Gontier,
France
| | - S. Barré
- />CH Haut Anjou Château Gontier, Château Gontier,
France
| | | | | | - A. M. Vidal
- />CH Le Mans, Le Mans, France
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - I. Cumin
- />CH Sud Lorient Hennebont, Hennebont, France
| | - J. Egreteau
- />CH Sud Lorient Hennebont, Hennebont, France
| | - A. Brouard
- />CH Sud Lorient Hennebont, Hennebont, France
| | | | | | | | | | | | | | - E. Crespeau
- />Polyclinique du Parc Cholet, Cholet, France
| | | | - H. Bourgeois
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - C. Riche
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - D. Déniel Lagadec
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - F. Marhuenda
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
| | - F. Grudé
- />Observatoire dédié au Cancer de l’OMEDIT
Bretagne et de l’OMEDIT Pays de la Loire, Rennes, France
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Abstract
Nearly half of all women diagnosed with breast or ovarian cancer are age 65 years or older with the number of women diagnosed expected to increase as the population ages and life expectancy improves. Older women are less likely to be offered standard cancer treatments, are more likely to develop higher toxicity, and have higher mortality. Chronologic age should not be the only factor used for making treatment decisions. Functional dependence, organ function, comorbidity, polypharmacy, social support, cognitive and/or psychosocial factors, overall life expectancy, and patient's goals of care are equally vital and should be assessed before and during treatment. In this review, current evidence and treatment guidelines for older women with breast or ovarian cancer are outlined.
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Abstract
SUMMARY The availability of new chemotherapeutic and targeted agents has changed the life expectancy of patients with metastatic colorectal cancer thanks to the possibility of sequentially administering fluoropyrimidines combined with irinotecan and oxaliplatin plus monoclonal antibodies. This approach is seldom feasible in the elderly, especially because of the poor tolerability of some agents. Frail patients should only receive palliative treatment. Oppositely, fit elderly patients can be treated with more aggressive therapies, similarly to the younger ones. What is not sufficiently known is how to manage the elderly categorized as intermediate. In the coming years, it appears necessary how to accurately differentiate the elderly through a comprehensive geriatric assessment performed with validated scales and uniformed criteria simpler than those currently available.
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Affiliation(s)
- Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, University Hospital, Udine, Italy
| | - Elena Poletto
- Department of Medical Oncology, University Hospital, Udine, Italy
| | - Antonio Avallone
- Department of Gastrointestinal Medical Oncology, National Cancer Institute, Naples, Italy
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Lichtman SM. How I treat ovarian cancer in older women. J Geriatr Oncol 2014; 5:223-9. [DOI: 10.1016/j.jgo.2014.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/29/2014] [Accepted: 06/02/2014] [Indexed: 11/17/2022]
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Castleberry AW, Güller U, Tarantino I, Berry MF, Brügger L, Warschkow R, Cerny T, Mantyh CR, Candinas D, Worni M. Discrete improvement in racial disparity in survival among patients with stage IV colorectal cancer: a 21-year population-based analysis. J Gastrointest Surg 2014; 18:1194-204. [PMID: 24733258 DOI: 10.1007/s11605-014-2515-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/24/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE Recently, multiple clinical trials have demonstrated improved outcomes in patients with metastatic colorectal cancer. This study investigated if the improved survival is race dependent. PATIENTS AND METHODS Overall and cancer-specific survival of 77,490 White and Black patients with metastatic colorectal cancer from the 1988-2008 Surveillance Epidemiology and End Results registry were compared using unadjusted and multivariable adjusted Cox proportional hazard regression as well as competing risk analyses. RESULTS Median age was 69 years, 47.4 % were female and 86.0 % White. Median survival was 11 months overall, with an overall increase from 8 to 14 months between 1988 and 2008. Overall survival increased from 8 to 14 months for White, and from 6 to 13 months for Black patients. After multivariable adjustment, the following parameters were associated with better survival: White, female, younger, better educated and married patients, patients with higher income and living in urban areas, patients with rectosigmoid junction and rectal cancer, undergoing cancer-directed surgery, having well/moderately differentiated, and N0 tumors (p < 0.05 for all covariates). Discrepancies in overall survival based on race did not change significantly over time; however, there was a significant decrease of cancer-specific survival discrepancies over time between White and Black patients with a hazard ratio of 0.995 (95 % confidence interval 0.991-1.000) per year (p = 0.03). CONCLUSION A clinically relevant overall survival increase was found from 1988 to 2008 in this population-based analysis for both White and Black patients with metastatic colorectal cancer. Although both White and Black patients benefitted from this improvement, a slight discrepancy between the two groups remained.
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Jiang T, Piao D, Zhu A, Jiang H. Changes in T lymphocyte subsets in mice with CT26 colon tumors after treatment with donor lymphocyte infusion. Tumour Biol 2014; 35:5599-605. [PMID: 24659423 DOI: 10.1007/s13277-014-1740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022] Open
Abstract
The objective of this study was to detect changes in T lymphocyte subpopulations in mice with CT26 subcutaneous colon cancer after treatment with donor lymphocyte infusion (DLI) and cyclophosphamide (CP) chemotherapy. A colon cancer model was established by subcutaneous injection of CT26 carcinoma cells into BALB/C mice. The mice were randomized into different treatment groups. We recorded survival times, tumor growth inhibition rates, histopathological changes, and T lymphocyte subsets in peripheral blood of the mice. Mice treated with DLI and CP survived 33.5 ± 5.02 days, which was significantly longer than the survival time of untreated control mice (16.7 ± 2.98 days, P < 0.01). In addition, the tumor inhibitory rate was higher in mice treated with DLI and CP (89.3 %) than that in mice treated with CP or DLI alone (67.1 and 34.5 %, respectively). There were higher levels of T lymphocytes that were CD3(+) and CD4(+) in mice treated with DLI alone or the combination of CP and DLI (P < 0.05), and the ratio of CD4(+)/CD8(+) cells was significantly improved in these mice (P < 0.05). DLI combined with chemotherapy significantly prolonged survival and inhibited tumor growth in mice with CT26 colon cancer. This treatment might also improve immune function in these mice. Donor spleen cells that include high numbers of allogeneic lymphocytes and a few stem cells could induce a graft-versus-tumor effect, leading to elimination of residual cancer cells. This indicates that it is potentially a feasible adoptive cellular immunotherapy strategy for the management of solid tumors.
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Affiliation(s)
- Tao Jiang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Str, Nangang District, Harbin, Heilongjiang Province, People's Republic of China
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Benavides M, Berciano-Guerrero M. Elderly patients with metastatic colorectal cancer: overall issues and first-line chemotherapy options. Colorectal Cancer 2013. [DOI: 10.2217/crc.13.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY The aging phenomenon is resulting in an ever greater incidence of colorectal cancer (CRC) in the elderly. Chronologic age is not the best or only way to define elderly patients because aging varies greatly. Comprehensive geriatric assessment has proved beneficial for more appropriate therapeutic options although its influence on treatment decisions and outcomes remains to be validated. Fit elderly patients with metastatic CRC derive similar benefits to their younger counterparts, but only one Phase III trial exists to define the best treatment. New strategies such as maintenance therapies, which are particularly appropriate in these patients, are needed. As very few data are available for the vulnerable/frail elderly population, it is important to better define these terms and the efficacy (if any) of treatment modalities in this group. Translational research in geriatric oncology must be improved in this heterogeneous population to identify biological and clinical correlates of cancer and aging, ameliorating personalized treatment in elderly metastatic CRC patients.
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Affiliation(s)
- Manuel Benavides
- Medical Oncology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain
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