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van der Hulst HC, van der Bol JM, Bastiaannet E, Portielje JEA, Dekker JWT. The effect of prehabilitation on long-term survival and hospital admissions in older patients undergoing elective colorectal cancer surgery. Eur J Surg Oncol 2024; 50:108244. [PMID: 38452716 DOI: 10.1016/j.ejso.2024.108244] [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: 10/24/2023] [Revised: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION There is a growing body of evidence for a beneficial effect of prehabilitation on short-term outcomes after colorectal cancer (CRC) surgery in older patients. However, long-term effects on survival or hospital admissions have not been investigated. This study reports these long-term outcomes from a previously published observational cohort study. METHODS We compared patients ≥75 years who received elective CRC surgery in Reinier de Graaf Hospital before (2010-2013: standard care) and after implementation of a multimodal prehabilitation program (2014-2015; prehabilitation). With a six-year follow-up period, we analyzed survival using the Kaplan-Meier method and the occurrence of one or more hospital admissions using logistic regression analyses. RESULTS Overall, 137 patients were included in the standard care group and 86 patients in the prehabilitation group. There were no differences in patients, tumor and treatment characteristics. After six years, 51.1% in the standard care group and 59.3% in the prehabilitation group (p = 0.167) were still alive. When corrected for confounders in the prehabilitation group less patients had one or more hospital admissions during follow-up (odds ratio (OR) 0.43 (95% CI 0.24-0.77). CONCLUSIONS Unfortunately these limited historical cohorts did not allow for strong conclusions concerning long-time survival. However, after prehabilitation less patients had hospital admissions during follow up. Hopefully, this first study into the long-term effects of multimodal prehabilitation will trigger more future research.
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Affiliation(s)
- Heleen C van der Hulst
- Department of Surgery, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands.
| | - Jessica M van der Bol
- Department of Geriatric Medicine, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Esther Bastiaannet
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
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Hultink D, Souwer ETD, Bastiaannet E, Dekker JWT, Steup WH, Hamaker ME, Sonneveld DJA, Consten ECJ, Neijenhuis PA, Portielje JEA, van den Bos F. The prognostic value of a geriatric risk score for older patients undergoing emergency surgery of colorectal cancer: A retrospective cohort study. J Geriatr Oncol 2024; 15:101711. [PMID: 38310662 DOI: 10.1016/j.jgo.2024.101711] [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: 09/09/2023] [Revised: 12/24/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Emergency surgery of colorectal cancer is associated with high mortality rates in older patients. We investigated whether information on four geriatric domains has prognostic value for 30-day mortality and postoperative morbidity including severe complications. MATERIALS AND METHODS All consecutive patients aged 70 years or older who underwent emergency colorectal cancer surgery in six Dutch hospitals (2014-2017) were studied. Presence of geriatric risk factors was scored prior to surgery as either 0 (risk absent) or 1 (risk present) in each of four geriatric domains and summed up to calculate a sumscore with a value between 0 and 4. In addition, we separately investigated the use of a mobility aid. Primary outcome was 30-day mortality. Secondary outcomes were any postoperative complications and severe complications. Multivariable logistic regression model was used to evaluate the sumscore and outcomes. RESULTS Two hundred seven patients were included. Median age was 79.4 years. One hundred seventy-five patients (76%) presented with obstruction, 22 (11%) with a perforation, and 17 (8%) with severe anemia. Mortality rates were 2.9%, 13.6%, and 29.6% for patients with a sumscore of 0, 1-2, and 3-4 respectively, with odds ratio (OR) 4.8 [95% confidence interval (CI) 1.03-22.95] and OR 10.6 [95% CI 1.99-56.34] for a sumscore of 1-2 and 3-4 respectively. Use of a mobility aid was associated with increased mortality OR 8.0 [95% CI 2.74-23.43] and severe complications OR 2.31 [95% CI 1.17-4.55]. DISCUSSION This geriatric sumscore and the use of a mobility aid have strong association with 30-day mortality after emergency surgery of colorectal cancer. This could provide better insight into surgical risk and help select high-risk patients for alternative strategies.
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Affiliation(s)
- Daniëlle Hultink
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands.
| | - Esteban T D Souwer
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - W H Steup
- Department of Surgery, Haga Hospital, The Hague, the Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | | | - Esther C J Consten
- Department of Surgery, Meander Medisch Centrum, Amersfoort, the Netherlands
| | | | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Geriatric Medicine, University Medical Center Leiden, Utrecht, the Netherlands
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Waaijer MEC, Lemij AA, de Boer AZ, Bastiaannet E, van den Bos F, Derks MGM, Kroep JR, Liefers GJ, Portielje JEA, de Glas NA. The impact of geriatric characteristics and comorbidities on distant metastases and other cause mortality in older women with non-metastatic breast cancer treated with primary endocrine therapy. Breast Cancer Res Treat 2023; 201:471-478. [PMID: 37479944 PMCID: PMC10460719 DOI: 10.1007/s10549-023-07029-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/08/2022] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION In recent years, primary surgical treatment of older women with non-metastatic breast cancer has decreased in favor of primary endocrine therapy (PET). PET can be considered in women with a remaining life expectancy of less than five years. The aim of this study was to (1) assess the risk of distant metastases and other cause mortality over ten years in women aged 65 and older with stage I-III breast cancer treated with PET, (2) whether this was associated with geriatric characteristics and comorbidities and to (3) describe the reasons on which the choice for PET was made. METHODS Women were included from the retrospective FOCUS cohort, which comprises all incident women diagnosed with breast cancer aged 65 or older between January 1997 and December 2004 in the Comprehensive Cancer Center Region West in the Netherlands. We selected women (N = 257) with stage I-III breast cancer and treated with PET from this cohort. Patient characteristics (including comorbidity, polypharmacy, walking, cognitive and sensory impairment), treatment and tumor characteristics were retrospectively extracted from charts. Outcomes were distant metastasis and other cause mortality. Cumulative incidences were calculated using the Cumulative Incidence for Competing Risks method (CICR); and subdistribution hazard ratios (SHR) were tested between groups based on age, geriatric characteristics and comorbidity with the Fine and Gray model. RESULTS Women treated with PET were on average 84 years old and 41% had one or more geriatric characteristics. Other cause mortality exceeded the cumulative incidence of distant metastasis over ten years (83 versus 5.6%). The risk of dying from another cause further increased in women with geriatric characteristics (SHR 2.06, p < 0.001) or two or more comorbidities (SHR 1.72, p < 0.001). Often the reason for omitting surgery was not recorded (52.9%), but if recorded surgery was omitted mainly at the patient's request (18.7%). DISCUSSION This study shows that the cumulative incidence of distant metastasis is much lower than other cause mortality in older women with breast cancer treated with PET, especially in the presence of geriatric characteristics or comorbidities. This confirms the importance of assessment of geriatric characteristics to aid counseling of older women.
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Affiliation(s)
- M E C Waaijer
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - A A Lemij
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - A Z de Boer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - F van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands.
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Goedegebuur J, Abbel D, Accassat S, Achterberg WP, Akbari A, Arfuch VM, Baddeley E, Bax JJ, Becker D, Bergmeijer B, Bertoletti L, Blom JW, Calvetti A, Cannegieter SC, Castro L, Chavannes NH, Coma-Auli N, Couffignal C, Edwards A, Edwards M, Enggaard H, Font C, Gava A, Geersing GJ, Geijteman ECT, Greenley S, Gregory C, Gussekloo J, Hoffmann I, Højen AA, van den Hout WB, Huisman MV, Jacobsen S, Jagosh J, Johnson MJ, Jørgensen L, Juffermans CCM, Kempers EK, Konstantinides S, Kroder AF, Kruip MJHA, Lafaie L, Langendoen JW, Larsen TB, Lifford K, van der Linden YM, Mahé I, Maiorana L, Maraveyas A, Martens ESL, Mayeur D, van Mens TE, Mohr K, Mooijaart SP, Murtagh FEM, Nelson A, Nielsen PB, Ording AG, Ørskov M, Pearson M, Poenou G, Portielje JEA, Raczkiewicz D, Rasmussen K, Trinks-Roerdink E, Schippers I, Seddon K, Sexton K, Sivell S, Skjøth F, Søgaard M, Szmit S, Trompet S, Vassal P, Visser C, van Vliet LM, Wilson E, Klok FA, Noble SIR. Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool. Thromb Res 2023; 228:54-60. [PMID: 37276718 DOI: 10.1016/j.thromres.2023.05.008] [Citation(s) in RCA: 1] [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: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. METHODS The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe. RESULTS SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. CONCLUSIONS We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.
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Affiliation(s)
- J Goedegebuur
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - D Abbel
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Medicine - Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - S Accassat
- Department of Vascular and Therapeutical Medicine, University Hospital of Saint-Etienne, Saint-Étienne, France
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - A Akbari
- Swansea University, Swansea, Wales, United Kingdom
| | - V M Arfuch
- Department of Medical Oncology, Hospital Clinic Barcelona, Clinical Institute of Haematological and Oncological Diseases (ICMHO), IDIBAPS, Barcelona, Spain
| | - E Baddeley
- Cardiff University, Cardiff, United Kingdom
| | - J J Bax
- Department of Medicine - Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - D Becker
- University Medical Center Mainz, Mainz, Germany
| | | | - L Bertoletti
- Department of Vascular and Therapeutical Medicine, Jean Monnet University, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - J W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - A Calvetti
- Assistance Publique-Hopitaux de Paris, Paris, France
| | - S C Cannegieter
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - L Castro
- Vall d'Hebron Research Institute, Barcelona, Spain
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - N Coma-Auli
- Department of Medical Oncology, Hospital Clinic Barcelona, Clinical Institute of Haematological and Oncological Diseases (ICMHO), IDIBAPS, Barcelona, Spain
| | - C Couffignal
- Hôpital Louis Mourier, APHP, Assistance Publique-Hopitaux de Paris, Paris, France
| | - A Edwards
- Cardiff University, Cardiff, United Kingdom
| | - M Edwards
- Cardiff University, Cardiff, United Kingdom
| | - H Enggaard
- Aalborg University Hospital, Aalborg, Denmark
| | - C Font
- Department of Medical Oncology, Hospital Clinic Barcelona, Clinical Institute of Haematological and Oncological Diseases (ICMHO), IDIBAPS, Barcelona, Spain
| | - A Gava
- Societa per l'Assistenza al Malato Oncologico Terminale Onlus (S.A.M.O.T.) Ragusa Onlus, Ragusa, Italy
| | - G J Geersing
- Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E C T Geijteman
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - S Greenley
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - C Gregory
- Cardiff University, Cardiff, United Kingdom
| | - J Gussekloo
- Department of Medicine - Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - I Hoffmann
- Hôpital Bichat, APHP, Assistance Publique-Hopitaux de Paris, Paris, France
| | - A A Højen
- Aalborg University Hospital, Aalborg, Denmark
| | - W B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - S Jacobsen
- Aalborg University Hospital, Aalborg, Denmark
| | - J Jagosh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - M J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - L Jørgensen
- Aalborg University Hospital, Aalborg, Denmark
| | - C C M Juffermans
- Centre of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
| | - E K Kempers
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - A F Kroder
- Todaytomorrow, Rotterdam, the Netherlands
| | - M J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L Lafaie
- Department of Geriatrics and Gerontology, Jean Monnet University, University Hospital of Saint-Étienne, Saint-Étienne, France
| | | | - T B Larsen
- Aalborg University Hospital, Aalborg, Denmark
| | - K Lifford
- Cardiff University, Cardiff, United Kingdom
| | - Y M van der Linden
- Centre of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - I Mahé
- Department of Innovative Therapies in Haemostasis, Hôpital Louis Mourier, APHP, Paris, France
| | - L Maiorana
- Societa per l'Assistenza al Malato Oncologico Terminale Onlus (S.A.M.O.T.) Ragusa Onlus, Ragusa, Italy
| | - A Maraveyas
- Clinical Sciences Centre Hull York Medical School University of Hull, Hull, United Kingdom
| | - E S L Martens
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - D Mayeur
- Centre Georges-François Leclerc, Dijon, France
| | - T E van Mens
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - K Mohr
- University Medical Center Mainz, Mainz, Germany
| | - S P Mooijaart
- Department of Medicine - Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - F E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - A Nelson
- Cardiff University, Cardiff, United Kingdom
| | - P B Nielsen
- Aalborg University Hospital, Aalborg, Denmark
| | - A G Ording
- Aalborg University Hospital, Aalborg, Denmark
| | - M Ørskov
- Aalborg University Hospital, Aalborg, Denmark
| | - M Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - G Poenou
- Department of Vascular and Therapeutical Medicine, Jean Monnet University, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - J E A Portielje
- Department of Medicine - Internal medicine and Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - D Raczkiewicz
- Department of Medical Statistics, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - K Rasmussen
- Aalborg University Hospital, Aalborg, Denmark
| | - E Trinks-Roerdink
- Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - K Seddon
- Wales Cancer Research Centre, Cardiff, UK
| | - K Sexton
- Cardiff University, Cardiff, United Kingdom
| | - S Sivell
- Cardiff University, Cardiff, United Kingdom
| | - F Skjøth
- Aalborg University Hospital, Aalborg, Denmark
| | - M Søgaard
- Aalborg University Hospital, Aalborg, Denmark
| | - S Szmit
- Department of Cardio-Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - S Trompet
- Department of Medicine - Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - P Vassal
- Department of Vascular and Therapeutical Medicine, University Hospital of Saint-Etienne, Saint-Étienne, France
| | - C Visser
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L M van Vliet
- Department of Health, Medicine and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - E Wilson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - F A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
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Souwer ETD, Sanchez-Spitman A, Moes DJAR, Gelderblom H, Swen JJ, Portielje JEA, Guchelaar HJ, van Gelder T. Tamoxifen pharmacokinetics and pharmacodynamics in older patients with non-metastatic breast cancer. Breast Cancer Res Treat 2023; 199:471-478. [PMID: 37067610 PMCID: PMC10175413 DOI: 10.1007/s10549-023-06925-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND We aimed to study the pharmacokinetics and -dynamics of tamoxifen in older women with non-metastatic breast cancer. METHODS Data for this analysis were derived from the CYPTAM study (NTR1509) database. Patients were stratified by age (age groups < 65 and 65 and older). Steady-state trough concentrations were measured of tamoxifen, N-desmethyltamoxifen, 4-hydroxy-tamoxifen, and endoxifen. CYP2D6 and CYP3A4 phenotypes were assessed for all patients by genotyping. Multiple linear regression models were used to analyze tamoxifen and endoxifen variability. Outcome data included recurrence-free survival at time of tamoxifen discontinuation (RFSt) and overall survival (OS). RESULTS 668 patients were included, 141 (21%) were 65 and older. Demographics and treatment duration were similar across age groups. Older patients had significantly higher concentrations of tamoxifen 129.4 ng/ml (SD 53.7) versus 112.2 ng/ml (SD 42.0) and endoxifen 12.1 ng/ml (SD 6.6) versus 10.7 ng/ml (SD 5.7, p all < 0.05), independently of CYP2D6 and CYP3A4 gene polymorphisms. Age independently explained 5% of the variability of tamoxifen (b = 0.95, p < 0.001, R2 = 0.051) and 0.1% of the variability in endoxifen concentrations (b = 0.45, p = 0.12, R2 = 0.007). Older patients had worse RFSt (5.8 versus 7.3 years, p = 0.01) and worse OS (7.8 years versus 8.7 years, p = 0.01). This was not related to differences in endoxifen concentration (HR 1.0, 95% CI 0.96-1.04, p = 0.84) or CYP polymorphisms. CONCLUSION Serum concentrations of tamoxifen and its demethylated metabolites are higher in older patients, independent of CYP2D6 or CYP3A4 gene polymorphisms. A higher bioavailability of tamoxifen in older patients may explain the observed differences. However, clinical relevance of these findings is limited and should not lead to a different tamoxifen dose in older patients.
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Affiliation(s)
- E T D Souwer
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A Sanchez-Spitman
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - D J A R Moes
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - J J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - H J Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - T van Gelder
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
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Van Hoi ET, De Glas NA, Portielje JEA, Van Heemst D, Van Den Bos F, Jochems SP, Mooijaart SP. Biomarkers of the ageing immune system and their association with frailty - A systematic review. Exp Gerontol 2023; 176:112163. [PMID: 37028607 DOI: 10.1016/j.exger.2023.112163] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Ageing is associated with several physiological changes, including changes in the immune system. Age-related changes in the innate and adaptive immune system are thought to contribute to frailty. Understanding the immunological determinants of frailty could help to develop and deliver more effective care to older people. This systematic review aims to study the association between biomarkers of the ageing immune system and frailty. METHODS The search strategy was performed in PubMed and Embase, using the keywords "immunosenescence", "inflammation", "inflammaging" and "frailty". We included studies that investigated the association of biomarkers of the ageing immune system and frailty cross-sectionally in older adults, without an active disease that affects immune parameters. Three independent researchers selected the studies and performed data extraction. Study quality was assessed using the Newcastle-Ottawa scale adapted for cross-sectional studies. RESULTS A total of 44 studies, with a median number of 184 participants, was included. Study quality was good in 16 (36 %), moderate in 25 (57 %) and poor in 3 (7 %) of studies. The most frequently studied inflammaging biomarkers were IL-6, CRP and TNF-α. Associations with frailty were observed for increased levels of (i) IL-6 in 12 of 24 studies, (ii) CRP in 7 of 19 studies, and (ii) TNF-α in 4 of 13 studies. In none of the other studies were associations observed of frailty with these biomarkers. Different types of T-lymphocyte subpopulations were studied but each subset was studied only once, and the study sample sizes were low. CONCLUSION Our review of 44 studies on the relation between immune biomarkers and frailty identified IL-6 and CRP as the biomarkers that were most consistently associated with frailty. T-lymphocyte subpopulations were investigated but too infrequently to draw strong conclusions yet, although initial results are promising. Additional studies are required in order to further validate these immune biomarkers in larger cohorts. Furthermore, prospective studies in more uniform settings and larger cohorts are needed to further investigate the association with immune candidate biomarkers for which potential associations with ageing and frailty were previously observed, before these can be used in clinical practice to help assess frailty and improve the care treatments of older patients.
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Affiliation(s)
- E Tran Van Hoi
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
| | - N A De Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - D Van Heemst
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - F Van Den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - S P Jochems
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - S P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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7
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van der Hulst HC, van der Bol JM, Bastiaannet E, Portielje JEA, Dekker JWT. Surgical and non-surgical complications after colorectal cancer surgery in older patients; time-trends and age-specific differences. Eur J Surg Oncol 2023; 49:724-729. [PMID: 36635163 DOI: 10.1016/j.ejso.2022.11.095] [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: 06/02/2022] [Revised: 11/05/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trends of surgical and non-surgical complications among the old, older and oldest patients after colorectal cancer (CRC) surgery could help to identify the best target outcome to further improve postoperative outcome. MATERIALS AND METHODS All consecutive patients ≥70 years receiving curative elective CRC resection between 2011 and 2019 in The Netherlands were included. Baseline variables and postoperative complications were prospectively collected by the Dutch ColoRectal audit (DCRA). We assessed surgical and non-surgical complications over time and within age categories (70-74, 75-79 and ≥ 80 years) and determined the impact of age on the risk of both types of complications by using multivariate logistic regression analyses. RESULTS Overall, 38648 patients with a median age of 76 years were included. Between 2011 and 2019 the proportion of ASA score ≥3 and laparoscopic surgery increased. Non-surgical complications significantly improved between 2011 (21.8%) and 2019 (17.1%) and surgical complications remained constant (from 17.6% to 16.8%). Surgical complications were stable over time for each age group. Non-surgical complications improved in the oldest two age groups. Increasing age was only associated with non-surgical complications (75-79 years; OR 1.17 (95% CI 1.10-1.25), ≥80 years; OR 1.46 (95% CI 1.37-1.55) compared to 70-74 years), not with surgical complications. CONCLUSION The reduction of postoperative complications in the older CRC population was predominantly driven by a decrease in non-surgical complications. Moreover, increasing age was only associated with non-surgical complications and not with surgical complications. Future care developments should focus on non-surgical complications, especially in patients ≥75 years.
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Affiliation(s)
| | | | - Esther Bastiaannet
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
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8
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Lemij AA, Baltussen JC, de Glas NA, Kroep JR, Derks MGM, Liefers GJ, Portielje JEA. Gene expression signatures in older patients with breast cancer: A systematic review. Crit Rev Oncol Hematol 2023; 181:103884. [PMID: 36442749 DOI: 10.1016/j.critrevonc.2022.103884] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/19/2022] [Revised: 09/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Gene expression signatures have emerged to predict prognosis and guide the use of adjuvant therapy in patients with hormone receptor-positive breast cancer. The objective of this systematic review was to evaluate the prognostic and predictive value of commercially available gene expression signatures as a tool in adjuvant treatment decision-making in older patients with breast cancer. METHODS PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, and Emcare were reviewed for relevant articles published before December 2021. Eligible studies were randomised trials and cohort studies that externally validated commercially available gene expression signatures in patients aged 65 years and older, including studies that presented subanalyses of this age group. Data extraction and risk of bias assessment was performed independently by two investigators. RESULTS Fifteen studies were included. Most studies investigated Oncotype DX, while results from other gene expression signatures were limited. Several studies underlined the prognostic performance of Oncotype DX and Prosigna Risk of Recurrence in older patients. Moreover, Oncotype DX was predictive for older patients with an intermediate-risk recurrence score; chemotherapy could be spared in both lymph node-positive and lymph node-negative disease. CONCLUSIONS Prognostic performance has been demonstrated in older patients for several gene expression signatures. However, additional validation in patients with high-risk tumours is needed before gene expression signatures can be implemented in clinical practice as a prediction tool for adjuvant chemotherapy decision-making in the older age group.
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Affiliation(s)
- A A Lemij
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J C Baltussen
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - M G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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9
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Bruin J, van Rood YR, Peeters KCMJ, de Roos C, Tanious R, Portielje JEA, Gelderblom H, Hinnen SCH. Efficacy of eye movement desensitization and reprocessing therapy for fear of cancer recurrence among cancer survivors: a randomized single-case experimental design. Eur J Psychotraumatol 2023; 14:2203427. [PMID: 37144665 PMCID: PMC10165926 DOI: 10.1080/20008066.2023.2203427] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Background: Fear of cancer recurrence (FCR) is one of the greatest problems with which cancer survivors have to deal. High levels of FCR are characterized by intrusive thoughts about cancer-related events and re-experiencing these events, avoidance of reminders of cancer, and hypervigilance, similar to post-traumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) therapy focuses on these images and memories. It is effective in reducing PTSD and may be effective in reducing high levels of FCR.Objective: The aim of the present study is to investigate the effectiveness of EMDR for severe FCR in breast and colorectal cancer survivors.Method: A multiple-baseline single-case experimental design (n = 8) was used. Daily repeated measurements for FCR were taken during the baseline phase and treatment phase, post-treatment, and at the 3 month follow-up. Participants answered the Cancer Worry Scale (CWS) and the Fear of Cancer Recurrence Inventory, Dutch version (FCRI-NL) five times, i.e. at the start and at the end of each phase (baseline, treatment, post-treatment, and follow-up). The study was prospectively registered at clinicaltrials.gov (NL8223).Results: Visual analysis and effect size calculation by Tau-U were executed for the daily questionnaire on FCR. The weighted average Tau-U score was .63 (p < .01) for baseline versus post-treatment, indicating large change, and .53 (p < .01) between baseline and follow-up, indicating moderate change. The scores on the CWS and FCRI-NL-SF decreased significantly from baseline to follow-up.Conclusion: The results seem promising for EMDR therapy as a potentially effective treatment for FCR. Further research is recommended.
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Affiliation(s)
- J Bruin
- Department of Psycho Oncology, Leiden University Medical Center (LUMC), RC Leiden, the Netherlands
| | - Y R van Rood
- Department of Psychiatry, Leiden University Medical Center (LUMC), ZA Leiden, the Netherlands
| | - K C M J Peeters
- Department of Surgery, Leiden University Medical Center (LUMC), ZA Leiden, the Netherlands
| | - C de Roos
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - R Tanious
- Methodology of Educational Sciences, Leuven, Belgium
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - S C H Hinnen
- Department of Psycho Oncology, Leiden University Medical Center (LUMC), RC Leiden, the Netherlands
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10
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Noordhoek I, Bastiaannet E, de Glas NA, Scheepens J, Esserman LJ, Wesseling J, Scholten AN, Schröder CP, Elias SG, Kroep JR, Portielje JEA, Kleijn M, Liefers GJ. Validation of the 70-gene signature test (MammaPrint) to identify patients with breast cancer aged ≥ 70 years with ultralow risk of distant recurrence: A population-based cohort study. J Geriatr Oncol 2022; 13:1172-1177. [PMID: 35871138 DOI: 10.1016/j.jgo.2022.07.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/22/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION When risk estimation in older patients with hormone receptor positive breast cancer (HR + BC) is based on the same factors as in younger patients, age-related factors regarding recurrence risk and other-cause mortality are not considered. Genomic risk assessment could help identify patients with ultralow risk BC who can forgo adjuvant treatment. However, assessment tools should be validated specifically for older patients. This study aims to determine whether the 70-gene signature test (MammaPrint) can identify patients with HR + BC aged ≥70 years with ultralow risk for distant recurrence. MATERIALS AND METHODS Inclusion criteria: ≥70 years; invasive HR + BC; T1-2N0-3M0. EXCLUSION CRITERIA HER2 + BC; neoadjuvant therapy. MammaPrint assays were performed following standardized protocols. Clinical risk was determined with St. Gallen risk classification. Primary endpoint was 10-year cumulative incidence rate of distant recurrence in relation to genomic risk. Subdistribution hazard ratios (sHR) were estimated from Fine and Gray analyses. Multivariate analyses were adjusted for adjuvant endocrine therapy and clinical risk. RESULTS This study included 418 patients, median age 78 years (interquartile range [IQR] 73-83). Sixty percent of patients were treated with endocrine therapy. MammaPrint classified 50 patients as MammaPrint-ultralow, 224 patients as MammaPrint-low, and 144 patients as MammaPrint-high risk. Regarding clinical risk, 50 patients were classified low, 237 intermediate, and 131 high. Discordance was observed between clinical and genomic risk in 14 MammaPrint-ultralow risk patients who were high clinical risk, and 84 patients who were MammaPrint-high risk, but low or intermediate clinical risk. Median follow-up was 9.2 years (IQR 7.9-10.5). The 10-year distant recurrence rate was 17% (95% confidence interval [CI] 11-23) in MammaPrint-high risk patients, 8% (4-12) in MammaPrint-low (HR 0.46; 95%CI 0.25-0.84), and 2% (0-6) in MammaPrint-ultralow risk patients (HR 0.11; 95%CI 0.02-0.81). After adjustment for clinical risk and endocrine therapy, MammaPrint-high risk patients still had significantly higher 10-year distant recurrence rate than MammaPrint-low (sHR 0.49; 95%CI 0.26-0.90) and MammaPrint-ultralow patients (sHR 0.12; 95%CI 0.02-0.85). Of the 14 MammaPrint-ultralow, high clinical risk patients none developed a distant recurrence. DISCUSSION These data add to the evidence validating MammaPrint's ultralow risk threshold. Even in high clinical risk patients, MammaPrint-ultralow risk patients remained recurrence-free ten years after diagnosis. These findings justify future studies into using MammaPrint to individualize adjuvant treatment in older patients.
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Affiliation(s)
- I Noordhoek
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Scheepens
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - L J Esserman
- Department of Surgical Oncology, University of California San Francisco, United States of America
| | - J Wesseling
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A N Scholten
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - M Kleijn
- Department of Medical Affairs, Agendia N.V., Amsterdam, the Netherlands
| | - G J Liefers
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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11
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van Rossum AGJ, Mandjes IAM, van Werkhoven E, van Tinteren H, van Leeuwen-Stok AE, Nederlof P, Portielje JEA, van Alphen RJ, Platte E, van den Broek D, Huitema A, Kok M, Linn SC, Oosterkamp HM. Carboplatin-Cyclophosphamide or Paclitaxel without or with Bevacizumab as First-Line Treatment for Metastatic Triple-Negative Breast Cancer (BOOG 2013-01). Breast Care (Basel) 2022; 16:598-606. [PMID: 35087363 DOI: 10.1159/000512200] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background The addition of bevacizumab to chemotherapy conferred a modest progression-free survival (PFS) benefit in metastatic triple-negative breast cancer (mTNBC). However, no overall survival (OS) benefit has been reported. Also, its combination with carboplatin-cyclophosphamide (CC) has never been investigated. Methods The Triple-B study is a multicenter, randomized phase IIb trial that aims to prospectively validate predictive biomarkers, including baseline plasma vascular endothelial growth factor receptor-2 (pVEGFR-2), for bevacizumab benefit. mTNBC patients were randomized between CC and paclitaxel (P) without or with bevacizumab (CC ± B or P ± B). Here we report on a preplanned safety and preliminary efficacy analysis after the first 12 patients had been treated with CC+B and on the predictive value of pVEGFR-2. Results In 58 patients, the median follow-up was 22.1 months. Toxicity was manageable and consistent with what was known for each agent separately. There was a trend toward a prolonged PFS with bevacizumab compared to chemotherapy only (7.0 vs. 5.2 months; adjusted HR = 0.60; 95% CI 0.33-1.08; p = 0.09), but there was no effect on OS. In this small study, pVEGFR-2 concentration did not predict a bevacizumab PFS benefit. Both the intention-to-treat analysis and the per-protocol analysis did not yield a significant treatment-by-biomarker test for interaction (pinteraction = 0.69). Conclusions CC and CC+B are safe first-line regimens for mTNBC and the side effects are consistent with those known for each individual agent. pVEGFR-2 concentration did not predict a bevacizumab PFS benefit.
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Affiliation(s)
- Annelot G J van Rossum
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Erik van Werkhoven
- Biometrics Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harm van Tinteren
- Biometrics Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Petra Nederlof
- Department of Molecular Diagnostics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, HagaZiekenhuis, The Hague, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robbert J van Alphen
- Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Els Platte
- Clinical Chemical Laboratory, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daan van den Broek
- Clinical Chemical Laboratory, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alwin Huitema
- Pharmacy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marleen Kok
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sabine C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - Hendrika M Oosterkamp
- Department of Medical Oncology, Haaglanden Medisch Centrum, The Hague, The Netherlands
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12
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Pieterse AH, Brandes K, de Graaf J, de Boer JE, Labrie NHM, Knops A, Allaart CF, Portielje JEA, Bos WJW, Stiggelbout AM. Fostering Patient Choice Awareness and Presenting Treatment Options Neutrally: A Randomized Trial to Assess the Effect on Perceived Room for Involvement in Decision Making. Med Decis Making 2021; 42:375-386. [PMID: 34727753 PMCID: PMC8918871 DOI: 10.1177/0272989x211056334] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose Shared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment. Methods We developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naïve participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance. Results A total of 324 patients and 360 disease-naïve respondents participated (mean age, 52 ± 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 ± 2.1 on a 3–15 scale). The results showed that choice awareness communication had a positive (Mpresent = 5.2 v. Mabsent = 5.0, P = 0.042, η2partial = 0.006) and physician preference communication had no (Mpresent = 5.0 v. Mabsent = 5.1, P = 0.144, η2partial = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (Mpresent = 4.7 v. Mabsent = 5.3, P = 0.006, η2partial = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust. Conclusions This is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Kim Brandes
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Jessica de Graaf
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Joyce E de Boer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anouk Knops
- Dutch Federation of Patients' Organizations, Quality of Care Department, BM, Utrecht, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
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13
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Souwer ETD, Bastiaannet E, Steyerberg EW, Dekker JWT, Steup WH, Hamaker MM, Sonneveld DJA, Burghgraef TA, van den Bos F, Portielje JEA. A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older. Cancers (Basel) 2021; 13:cancers13133110. [PMID: 34206349 PMCID: PMC8268502 DOI: 10.3390/cancers13133110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Older patients have an increased risk of morbidity and mortality after colorectal cancer (CRC) surgery. Existing CRC surgical prediction models have not incorporated geriatric predictors, limiting applicability for preoperative decision-making. The objective was to develop and internally validate a predictive model based on preoperative predictors, including geriatric characteristics, for severe postoperative complications after elective surgery for stage I-III CRC in patients ≥70 years. PATIENTS AND METHODS A prospectively collected database contained 1088 consecutive patients from five Dutch hospitals (2014-2017) with 171 severe complications (16%). The least absolute shrinkage and selection operator (LASSO) method was used for predictor selection and prediction model building. Internal validation was done using bootstrapping. RESULTS A geriatric model that included gender, previous DVT or pulmonary embolism, COPD/asthma/emphysema, rectal cancer, the use of a mobility aid, ADL assistance, previous delirium and polypharmacy showed satisfactory discrimination with an AUC of 0.69 (95% CI 0.73-0.64); the AUC for the optimism corrected model was 0.65. Based on these predictors, the eight-item colorectal geriatric model (GerCRC) was developed. CONCLUSION The GerCRC is the first prediction model specifically developed for older patients expected to undergo CRC surgery. Combining tumour- and patient-specific predictors, including geriatric predictors, improves outcome prediction in the heterogeneous older population.
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Affiliation(s)
- Esteban T. D. Souwer
- Department of Internal Medicine, Haga Hospital, 2545 AA Den Haag, The Netherlands
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.B.); (J.E.A.P.)
- Correspondence:
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.B.); (J.E.A.P.)
| | - Ewout W. Steyerberg
- Department of Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Jan Willem T. Dekker
- Department of Surgery, Reinier De Graaf Gasthuis, 2625 AD Delft, The Netherlands;
| | - Willem H. Steup
- Department of Surgery, Haga Hospital, 2545 AA Den Haag, The Netherlands;
| | - Marije M. Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands;
| | | | - Thijs A. Burghgraef
- Department of Surgery, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands;
| | - Frederiek van den Bos
- Department of Geriatric Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Johanna E. A. Portielje
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (E.B.); (J.E.A.P.)
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14
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van der Hulst HC, Bastiaannet E, Portielje JEA, van der Bol JM, Dekker JWT. Can physical prehabilitation prevent complications after colorectal cancer surgery in frail older patients? Eur J Surg Oncol 2021; 47:2830-2840. [PMID: 34127328 DOI: 10.1016/j.ejso.2021.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Frail patients with colorectal cancer (CRC) are at increased risk of complications after surgery. Prehabilitation seems promising to improve this outcome and therefore we evaluated the effect of physical prehabilitation on postoperative complications in a retrospective cohort of frail CRC patients. METHODS The study consisted of all consecutive non-metastatic CRC patients ≥70 years who had elective surgery from 2014 to 2019 in a teaching hospital in the Netherlands, where a physical prehabilitation program was implemented from 2014 on. We performed both an intention-to-treat and per protocol analysis to evaluate postoperative complications in the physical prehabilitation (PhP) and non-prehabilitation (NP) group. RESULTS Eventually, 334 elective patients were included. The 124 (37.1%) patients in the PhP-group presented with higher age, higher comorbidity scores and walking-aid use compared to the NP-group. Medical complications occurred in 26.6% of the PhP-group and in 20.5% of the NP-group (p = 0.20) and surgical complications in 19.4% and 14.3% (p = 0.22) respectively. In all frailty subgroups, the medical complications were lower in the PhP-group compared to the NP-group (35.9% vs. 45.5% for patients with ≥2 comorbidities, 36.2% vs. 39.1% for ASA score ≥ III, 29.2% vs. 45.8% for walking-aid use). Differences were not significant. CONCLUSIONS In this study, patients selected for physical prehabilitation had a worse frailty profile and therefore a higher a priori risk of postoperative complications. However, the postoperative complication rate was not increased compared to patients who were less frail at baseline and without prehabilitation. Hence, physical prehabilitation may prevent postoperative complications in frail CRC patients ≥70 years.
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Affiliation(s)
- Heleen C van der Hulst
- Department of Surgery, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands.
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Jessica M van der Bol
- Department of Geriatric Medicine, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier De Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
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15
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Souwer ETD, Bastiaannet E, Steyerberg EW, Dekker JWT, van den Bos F, Portielje JEA. Risk prediction models for postoperative outcomes of colorectal cancer surgery in the older population - a systematic review. J Geriatr Oncol 2020; 11:1217-1228. [PMID: 32414672 DOI: 10.1016/j.jgo.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/29/2019] [Revised: 01/17/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND An increasing number of patients with Colorectal Cancer (CRC) is 65 years or older. We aimed to systematically review existing clinical prediction models for postoperative outcomes of CRC surgery, study their performance in older patients and assess their potential for preoperative decision making. METHODS A systematic search in Pubmed and Embase for original studies of clinical prediction models for outcomes of CRC surgery. Bias and relevance for preoperative decision making with older patients were assessed using the CHARMS guidelines. RESULTS 26 prediction models from 25 publications were included. The average age of included patients ranged from 61 to 76. Two models were exclusively developed for 65 and older. Common outcomes were mortality (n = 10), anastomotic leakage (n = 7) and surgical site infections (n = 3). No prediction models for quality of life or physical functioning were identified. Age, gender and ASA score were common predictors; 12 studies included intraoperative predictors. For the majority of the models, bias for model development and performance was considered moderate to high. CONCLUSIONS Prediction models are available that address mortality and surgical complications after CRC surgery. Most models suffer from methodological limitations, and their performance for older patients is uncertain. Models that contain intraoperative predictors are of limited use for preoperative decision making. Future research should address the predictive value of geriatric characteristics to improve the performance of prediction models for older patients.
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Affiliation(s)
- Esteban T D Souwer
- Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewout W Steyerberg
- Department of Biochemical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frederiek van den Bos
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
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16
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Groen JV, Douwes TA, van Eycken E, van der Geest LGM, Johannesen TB, Besselink MG, Koerkamp BG, Wilmink JW, Bonsing BA, Portielje JEA, van de Velde CJH, Bastiaannet E, Mieog JSD. Treatment and Survival of Elderly Patients with Stage I-II Pancreatic Cancer: A Report of the EURECCA Pancreas Consortium. Ann Surg Oncol 2020; 27:5337-5346. [PMID: 32388741 PMCID: PMC7669775 DOI: 10.1245/s10434-020-08539-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Indexed: 01/28/2023]
Abstract
Background Elderly patients with pancreatic cancer are underrepresented in clinical trials, resulting in a lack of evidence. Objective The aim of this study was to compare treatment and overall survival (OS) of patients aged ≥ 70 years with stage I–II pancreatic cancer in the EURECCA Pancreas Consortium. Methods This was an observational cohort study of the Belgian (BE), Dutch (NL), and Norwegian (NOR) cancer registries. The primary outcome was OS, while secondary outcomes were resection, 90-day mortality after resection, and (neo)adjuvant and palliative chemotherapy. Results In total, 3624 patients were included. Resection (BE: 50.2%; NL: 36.2%; NOR: 41.3%; p < 0.001), use of (neo)adjuvant chemotherapy (BE: 55.9%; NL: 41.9%; NOR: 13.8%; p < 0.001), palliative chemotherapy (BE: 39.5%; NL: 6.0%; NOR: 15.7%; p < 0.001), and 90-day mortality differed (BE: 11.7%; NL: 8.0%; NOR: 5.2%; p < 0.001). Furthermore, median OS in patients with (BE: 17.4; NL: 15.9; NOR: 25.4 months; p < 0.001) and without resection (BE: 7.0; NL: 3.9; NOR: 6.5 months; p < 0.001) also differed. Conclusions Differences were observed in treatment and OS in patients aged ≥ 70 years with stage I–II pancreatic cancer, between the population-based cancer registries. Future studies should focus on selection criteria for (non)surgical treatment in older patients so that clinicians can tailor treatment. Electronic supplementary material The online version of this article (10.1245/s10434-020-08539-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesse V Groen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Tom A Douwes
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | | | - Lydia G M van der Geest
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Tom B Johannesen
- Registry Department, The Cancer Registry of Norway, Oslo, Norway
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johanna W Wilmink
- Department of Medical Oncology, Cancer Center Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelus J H van de Velde
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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17
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de Boer AZ, de Glas NA, Marang-van de Mheen PJ, Dekkers OM, Siesling S, de Munck L, de Ligt KM, Liefers GJ, Portielje JEA, Bastiaannet E. Effect of omission of surgery on survival in patients aged 80 years and older with early-stage hormone receptor-positive breast cancer. Br J Surg 2020; 107:1145-1153. [PMID: 32259294 PMCID: PMC7496090 DOI: 10.1002/bjs.11568] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/07/2019] [Accepted: 02/02/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgery is increasingly being omitted in older patients with operable breast cancer in the Netherlands. Although omission of surgery can be considered in frail older patients, it may lead to inferior outcomes in non-frail patients. Therefore, the aim of this study was to evaluate the effect of omission of surgery on relative and overall survival in older patients with operable breast cancer. METHODS Patients aged 80 years or older diagnosed with stage I-II hormone receptor-positive breast cancer between 2003 and 2009 were selected from the Netherlands Cancer Registry. An instrumental variable approach was applied to minimize confounding, using hospital variation in rate of primary surgery. Relative and overall survival was compared between patients treated in hospitals with different rates of surgery. RESULTS Overall, 6464 patients were included. Relative survival was lower for patients treated in hospitals with lower compared with higher surgical rates (90·2 versus 92·4 per cent respectively after 5 years; 71·6 versus 88·2 per cent after 10 years). The relative excess risk for patients treated in hospitals with lower surgical rates was 2·00 (95 per cent c.i. 1·17 to 3·40). Overall survival rates were also lower among patients treated in hospitals with lower compared with higher surgical rates (48·3 versus 51·3 per cent after 5 years; 15·0 versus 19·7 per cent after 10 years respectively; adjusted hazard ratio 1·07, 95 per cent c.i. 1·00 to 1·14). CONCLUSION Omission of surgery is associated with worse relative and overall survival in patients aged 80 years or more with stage I-II hormone receptor-positive breast cancer. Future research should focus on the effect on quality of life and physical functioning.
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Affiliation(s)
- A Z de Boer
- Department of Surgery, Leiden, the Netherlands.,Department of Medical Oncology, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden, the Netherlands
| | | | - O M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - S Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - L de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - K M de Ligt
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - G J Liefers
- Department of Surgery, Leiden, the Netherlands
| | | | - E Bastiaannet
- Department of Surgery, Leiden, the Netherlands.,Department of Medical Oncology, Leiden, the Netherlands
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18
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van Rossum AGJ, Kok M, van Werkhoven E, Opdam M, Mandjes IAM, van Leeuwen-Stok AE, van Tinteren H, Imholz ALT, Portielje JEA, Bos MMEM, van Bochove A, Wesseling J, Rutgers EJ, Linn SC, Oosterkamp HM. Adjuvant dose-dense doxorubicin-cyclophosphamide versus docetaxel-doxorubicin-cyclophosphamide for high-risk breast cancer: First results of the randomised MATADOR trial (BOOG 2004-04). Eur J Cancer 2019; 102:40-48. [PMID: 30125761 DOI: 10.1016/j.ejca.2018.07.013] [Citation(s) in RCA: 6] [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] [Received: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dose-dense administration of chemotherapy and the addition of taxanes to anthracycline-based adjuvant chemotherapy have improved breast cancer survival substantially. However, clinical trials directly comparing the additive value of taxanes with dose-dense anthracycline-based chemotherapy are lacking. PATIENTS AND METHODS In the multicentre, randomised, biomarker discovery Microarray Analysis in breast cancer to Tailor Adjuvant Drugs Or Regimens (MATADOR) trial, patients with pT1-3, pN0-3 breast cancer were randomised (1:1) between six adjuvant cycles of doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 every 2 weeks (ddAC) and six cycles of docetaxel 75 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 every 3 weeks (TAC). The primary objective was to discover a predictive gene expression profile for ddAC and TAC benefit. Here we report the preplanned secondary end-point recurrence-free survival (RFS) and overall survival (OS). RESULTS Between 2004 and 2012, 664 patients were randomised. At 5 years, RFS was 87% (95% confidence interval [CI] 83%-91%) in the ddAC-treated patients and 88% (84-92%) in the TAC-treated subgroup (hazard ratio [HR] 0.89, 95% CI 0.62-1.28, P = 0.53). OS at 5 years was 93% (90%-96%) in the ddAC-treated and 94% (91%-97%) in the TAC-treated patients (HR 0.89, 95% CI 0.57-1.39, P = 0.61). Anaemia was more frequent in ddAC-treated patients (62/327 patients [18.9%] versus 15/319 patients [4.7%], P < 0.001) and diarrhoea (21 [6.4%] versus 53 [16.6%], P<0.001) and peripheral neuropathy (15 [4.6%] versus 46 [14.4%], P < 0.001) were observed more often in TAC-treated patients. CONCLUSIONS With a median follow-up of 7 years, no significant differences in RFS and OS were observed between six adjuvant cycles of ddAC and TAC in high-risk breast cancer patients. TRIAL REGISTRATION NUMBERS ISRCTN61893718 and BOOG 2004-04.
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Affiliation(s)
- A G J van Rossum
- Department of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - M Kok
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E van Werkhoven
- Biometrics Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - M Opdam
- Department of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - I A M Mandjes
- Data Centre, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A E van Leeuwen-Stok
- Dutch Breast Cancer Research Group, BOOG Study Centre, IJsbaanpad 9-11, 1076 CV, Amsterdam, The Netherlands
| | - H van Tinteren
- Biometrics Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A L T Imholz
- Department of Medical Oncology, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands
| | - J E A Portielje
- Department of Medical Oncology, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545 AA, The Hague, The Netherlands
| | - M M E M Bos
- Department of Internal Oncology, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - A van Bochove
- Department of Medical Oncology, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV, Zaandam, The Netherlands
| | - J Wesseling
- Department of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands; Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E J Rutgers
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - S C Linn
- Department of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands; Department of Pathology, University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - H M Oosterkamp
- Department of Medical Oncology, Haaglanden Medisch Centrum, The Hague, The Netherlands
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19
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Noordhoek I, de Groot AF, Cohen D, Liefers GJ, Portielje JEA, Kroep JR. Higher ER load is not associated with better outcome in stage 1-3 breast cancer: a descriptive overview of quantitative HR analysis in operable breast cancer. Breast Cancer Res Treat 2019; 176:27-36. [PMID: 30997625 PMCID: PMC6548750 DOI: 10.1007/s10549-019-05233-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/04/2019] [Accepted: 04/10/2019] [Indexed: 12/25/2022]
Abstract
Purpose In breast cancer, hormone receptor (HR) status is generally a qualitative measure; positive or negative. Quantitatively measured oestrogen and progesterone receptors (ER and PR) are frequently proposed prognostic and predictive markers, some guidelines even provide different treatment options for patients with strong versus weak expression. Aim To evaluate quantitative HR load assessed by immunohistochemistry as a prognostic and predictive measure in stage 1–3 breast cancer. Methods We reviewed all the available literature on quantitatively measured HRs using immunohistochemistry. Results All included studies (n = 19) comprised a cohort of 30,754 patients. Only 2 out of 17 studies found a clear correlation between higher quantitative ER and better disease outcome. Only one trial examined quantitative ER both as prognostic and predictive marker and found no association between ER% and survival. Ten studies examined quantitative PR load, only two of those found a significant correlation between higher PR load and better disease outcome. Two trials examined quantitative PR both as prognostic and predictive marker, neither found any association between PR% and disease outcome. Conclusions There is no clear evidence for using quantitatively assessed ER and PR as prognostic nor predictive marker in patients with stage 1–3 breast cancer. We recommend only using a qualitative HR status in future guidelines and treatment considerations. Electronic supplementary material The online version of this article (10.1007/s10549-019-05233-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Noordhoek
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - A F de Groot
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Cohen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
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20
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Claassen YHM, Bastiaannet E, van Eycken E, Van Damme N, Martling A, Johansson R, Iversen LH, Ingeholm P, Lemmens VEPP, Liefers GJ, Holman FA, Dekker JWT, Portielje JEA, Rutten HJ, van de Velde CJH. Time trends of short-term mortality for octogenarians undergoing a colorectal resection in North Europe. Eur J Surg Oncol 2019; 45:1396-1402. [PMID: 31003722 DOI: 10.1016/j.ejso.2019.03.041] [Citation(s) in RCA: 6] [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] [Received: 01/08/2019] [Revised: 03/10/2019] [Accepted: 03/28/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Decreased cancer specific survival in older colorectal patients is mainly due to mortality in the first year, emphasizing the importance of the first postoperative year. This study aims to gain an overview and time trends of short-term mortality in octogenarians (≥80 years) with colorectal cancer across four North European countries. METHODS Patients of 80 years or older, operated for colorectal cancer (stage I-III) between 2005 and 2014, were included. Population-based cohorts from Belgium, Denmark, the Netherlands, and Sweden were collected. Separately for colon- and rectal cancer, 30-day, 90-day, one-year, and excess one-year mortality were calculated. Also, short-term mortality over three time periods (2005-2008, 2009-2011, 2012-2014) was analyzed. RESULTS In total, 35,158 colon cancer patients and 10,144 rectal cancer patients were included. For colon cancer, 90-day mortality rate was highest in Denmark (15%) and lowest in Sweden (8%). For rectal cancer, 90-day mortality rate was highest in Belgium (11%) and lowest in Sweden (7%). One-year excess mortality rate of colon cancer patients decreased from 2005 to 2008 to 2012-2014 for all countries (Belgium: 17%-11%, Denmark: 21%-15%, the Netherlands: 18%-10%, and Sweden: 10%-8%). For rectal cancer, from 2005 to 2008 to 2012-2014 one-year excess mortality rate decreased in the Netherlands from 16% to 7% and Sweden: 8%-2%). CONCLUSIONS Short-term mortality rates were high in octogenarians operated for colorectal cancer. Short-term mortality rates differ across four North European countries, but decreased over time for both colon and rectal cancer patients in all countries.
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Affiliation(s)
- Y H M Claassen
- Department of Surgical Oncology, Leiden University Medical Center, the Netherlands.
| | - E Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - R Johansson
- Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
| | - L H Iversen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark; Danish Colorectal Cancer Group (DCCG.dk), Copenhagen, Denmark
| | - P Ingeholm
- Department of Pathology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - V E P P Lemmens
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - G J Liefers
- Department of Surgical Oncology, Leiden University Medical Center, the Netherlands
| | - F A Holman
- Department of Surgical Oncology, Leiden University Medical Center, the Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - H J Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - C J H van de Velde
- Department of Surgical Oncology, Leiden University Medical Center, the Netherlands.
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21
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Henricks LM, Lunenburg CATC, de Man FM, Meulendijks D, Frederix GWJ, Kienhuis E, Creemers GJ, Baars A, Dezentjé VO, Imholz ALT, Jeurissen FJF, Portielje JEA, Jansen RLH, Hamberg P, Ten Tije AJ, Droogendijk HJ, Koopman M, Nieboer P, van de Poel MHW, Mandigers CMPW, Rosing H, Beijnen JH, van Werkhoven E, van Kuilenburg ABP, van Schaik RHN, Mathijssen RHJ, Swen JJ, Gelderblom H, Cats A, Guchelaar HJ, Schellens JHM. A cost analysis of upfront DPYD genotype-guided dose individualisation in fluoropyrimidine-based anticancer therapy. Eur J Cancer 2018; 107:60-67. [PMID: 30544060 DOI: 10.1016/j.ejca.2018.11.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fluoropyrimidine therapy including capecitabine or 5-fluorouracil can result in severe treatment-related toxicity in up to 30% of patients. Toxicity is often related to reduced activity of dihydropyrimidine dehydrogenase, the main metabolic fluoropyrimidine enzyme, primarily caused by genetic DPYD polymorphisms. In a large prospective study, it was concluded that upfront DPYD-guided dose individualisation is able to improve safety of fluoropyrimidine-based therapy. In our current analysis, we evaluated whether this strategy is cost saving. METHODS A cost-minimisation analysis from a health-care payer perspective was performed as part of the prospective clinical trial (NCT02324452) in which patients prior to start of fluoropyrimidine-based therapy were screened for the DPYD variants DPYD*2A, c.2846A>T, c.1679T>G and c.1236G>A and received an initial dose reduction of 25% (c.2846A>T, c.1236G>A) or 50% (DPYD*2A, c.1679T>G). Data on treatment, toxicity, hospitalisation and other toxicity-related interventions were collected. The model compared prospective screening for these DPYD variants with no DPYD screening. One-way and probabilistic sensitivity analyses were also performed. RESULTS Expected total costs of the screening strategy were €2599 per patient compared with €2650 for non-screening, resulting in a net cost saving of €51 per patient. Results of the probabilistic sensitivity and one-way sensitivity analysis demonstrated that the screening strategy was very likely to be cost saving or worst case cost-neutral. CONCLUSIONS Upfront DPYD-guided dose individualisation, improving patient safety, is cost saving or cost-neutral but is not expected to yield additional costs. These results endorse implementing DPYD screening before start of fluoropyrimidine treatment as standard of care.
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Affiliation(s)
- Linda M Henricks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Meulendijks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emma Kienhuis
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Vincent O Dezentjé
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, the Netherlands; Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Frank J F Jeurissen
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands
| | - Rob L H Jansen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul Hamberg
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Albert J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | - Helga J Droogendijk
- Department of Internal Medicine, Bravis Hospital, Roosendaal, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter Nieboer
- Department of Internal Medicine, Wilhelmina Hospital Assen, Assen, the Netherlands
| | | | | | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - André B P van Kuilenburg
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology & Metabolism, Amsterdam, the Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Annemieke Cats
- Department of Gastrointestinal Oncology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H M Schellens
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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22
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Souwer ETD, Hultink D, Bastiaannet E, Hamaker ME, Schiphorst A, Pronk A, van der Bol JM, Steup WH, Dekker JWT, Portielje JEA, van den Bos F. The Prognostic Value of a Geriatric Risk Score for Older Patients with Colorectal Cancer. Ann Surg Oncol 2018; 26:71-78. [PMID: 30362061 PMCID: PMC6338720 DOI: 10.1245/s10434-018-6867-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION VMS is a Dutch risk assessment tool for hospitalized older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal surgery. METHODS All consecutive patients over age 70 years who underwent elective colorectal cancer surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival. RESULTS Five hundred fifty patients were included. Median age was 76.5 years, and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival, with hazard ratio (HR) of 1.9 [95% confidence interval (CI) 1.1-3.5; p = 0.03] and 8.7 (95% CI 4.0-19.2; p < 0.001), respectively. Sumscores were also associated with postoperative complications (intermediate sumscore OR 1.8; 95% CI 1.2-2.7; high sumscore OR 2.4; 95% CI 1.02-5.5). CONCLUSIONS This easy-to-use geriatric sumscore has strong associations with long-term outcome and morbidity after colorectal cancer surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision-making.
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Affiliation(s)
- E T D Souwer
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.
| | - D Hultink
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - A Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - J M van der Bol
- Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - W H Steup
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F van den Bos
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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Henricks LM, Lunenburg CATC, de Man FM, Meulendijks D, Frederix GWJ, Kienhuis E, Creemers GJ, Baars A, Dezentjé VO, Imholz ALT, Jeurissen FJF, Portielje JEA, Jansen RLH, Hamberg P, Ten Tije AJ, Droogendijk HJ, Koopman M, Nieboer P, van de Poel MHW, Mandigers CMPW, Rosing H, Beijnen JH, Werkhoven EV, van Kuilenburg ABP, van Schaik RHN, Mathijssen RHJ, Swen JJ, Gelderblom H, Cats A, Guchelaar HJ, Schellens JHM. DPYD genotype-guided dose individualisation of fluoropyrimidine therapy in patients with cancer: a prospective safety analysis. Lancet Oncol 2018; 19:1459-1467. [PMID: 30348537 DOI: 10.1016/s1470-2045(18)30686-7] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fluoropyrimidine treatment can result in severe toxicity in up to 30% of patients and is often the result of reduced activity of the key metabolic enzyme dihydropyrimidine dehydrogenase (DPD), mostly caused by genetic variants in the gene encoding DPD (DPYD). We assessed the effect of prospective screening for the four most relevant DPYD variants (DPYD*2A [rs3918290, c.1905+1G>A, IVS14+1G>A], c.2846A>T [rs67376798, D949V], c.1679T>G [rs55886062, DPYD*13, I560S], and c.1236G>A [rs56038477, E412E, in haplotype B3]) on patient safety and subsequent DPYD genotype-guided dose individualisation in daily clinical care. METHODS In this prospective, multicentre, safety analysis in 17 hospitals in the Netherlands, the study population consisted of adult patients (≥18 years) with cancer who were intended to start on a fluoropyrimidine-based anticancer therapy (capecitabine or fluorouracil as single agent or in combination with other chemotherapeutic agents or radiotherapy). Patients with all tumour types for which fluoropyrimidine-based therapy was considered in their best interest were eligible. We did prospective genotyping for DPYD*2A, c.2846A>T, c.1679T>G, and c.1236G>A. Heterozygous DPYD variant allele carriers received an initial dose reduction of 25% (c.2846A>T and c.1236G>A) or 50% (DPYD*2A and c.1679T>G), and DPYD wild-type patients were treated according to the current standard of care. The primary endpoint of the study was the frequency of severe (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 grade ≥3) overall fluoropyrimidine-related toxicity across the entire treatment duration. We compared toxicity incidence between DPYD variant allele carriers and DPYD wild-type patients on an intention-to-treat basis, and relative risks (RRs) for severe toxicity were compared between the current study and a historical cohort of DPYD variant allele carriers treated with full dose fluoropyrimidine-based therapy (derived from a previously published meta-analysis). This trial is registered with ClinicalTrials.gov, number NCT02324452, and is complete. FINDINGS Between April 30, 2015, and Dec 21, 2017, we enrolled 1181 patients. 78 patients were considered non-evaluable, because they were retrospectively identified as not meeting inclusion criteria, did not start fluoropyrimidine-based treatment, or were homozygous or compound heterozygous DPYD variant allele carriers. Of 1103 evaluable patients, 85 (8%) were heterozygous DPYD variant allele carriers, and 1018 (92%) were DPYD wild-type patients. Overall, fluoropyrimidine-related severe toxicity was higher in DPYD variant carriers (33 [39%] of 85 patients) than in wild-type patients (231 [23%] of 1018 patients; p=0·0013). The RR for severe fluoropyrimidine-related toxicity was 1·31 (95% CI 0·63-2·73) for genotype-guided dosing compared with 2·87 (2·14-3·86) in the historical cohort for DPYD*2A carriers, no toxicity compared with 4·30 (2·10-8·80) in c.1679T>G carriers, 2·00 (1·19-3·34) compared with 3·11 (2·25-4·28) for c.2846A>T carriers, and 1·69 (1·18-2·42) compared with 1·72 (1·22-2·42) for c.1236G>A carriers. INTERPRETATION Prospective DPYD genotyping was feasible in routine clinical practice, and DPYD genotype-based dose reductions improved patient safety of fluoropyrimidine treatment. For DPYD*2A and c.1679T>G carriers, a 50% initial dose reduction was adequate. For c.1236G>A and c.2846A>T carriers, a larger dose reduction of 50% (instead of 25%) requires investigation. Since fluoropyrimidines are among the most commonly used anticancer agents, these findings suggest that implementation of DPYD genotype-guided individualised dosing should be a new standard of care. FUNDING Dutch Cancer Society.
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Affiliation(s)
- Linda M Henricks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Carin A T C Lunenburg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Didier Meulendijks
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, Netherlands
| | - Geert W J Frederix
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Emma Kienhuis
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, Netherlands
| | - Vincent O Dezentjé
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, Netherlands; Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Frank J F Jeurissen
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands; Department of Internal Medicine, Haga Hospital, The Hague, Netherlands
| | - Rob L H Jansen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Paul Hamberg
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
| | - Albert J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Breda, Netherlands
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Peter Nieboer
- Department of Internal Medicine, Wilhelmina Hospital Assen, Assen, Netherlands
| | | | | | - Hilde Rosing
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - André B P van Kuilenburg
- Laboratory of Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology and Metabolism, Amsterdam, Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jesse J Swen
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Annemieke Cats
- Department of Gastrointestinal Oncology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Jan H M Schellens
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands.
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24
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Claassen YHM, Dikken JL, Hartgrink HH, de Steur WO, Slingerland M, Verhoeven RHA, van Eycken E, de Schutter H, Johansson J, Rouvelas I, Johnson E, Hjortland GO, Jensen LS, Larsson HJ, Allum WH, Portielje JEA, Bastiaannet E, van de Velde CJH. North European comparison of treatment strategy and survival in older patients with resectable gastric cancer: A EURECCA upper gastrointestinal group analysis. Eur J Surg Oncol 2018; 44:1982-1989. [PMID: 30343998 DOI: 10.1016/j.ejso.2018.09.014] [Citation(s) in RCA: 5] [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: 05/10/2018] [Revised: 09/14/2018] [Accepted: 09/21/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND As older gastric cancer patients are often excluded from randomized clinical trials, the most appropriate treatment strategy for these patients remains unclear. The current study aimed to gain more insight in treatment strategies and relative survival of older patients with resectable gastric cancer across Europe. METHODS Population-based cohorts from Belgium, Denmark, The Netherlands, Norway, and Sweden were combined. Patients ≥70 years with resectable gastric cancer (cT1-4a, cN0-2, cM0), diagnosed between 2004 and 2014 were included. Resection rates, administration of chemotherapy (irrespective of surgery), and relative survival within a country according to stage were determined. RESULTS Overall, 6698 patients were included. The percentage of operated patients was highest in Belgium and lowest in Sweden for both stage II (74% versus 56%) and stage III disease (57% versus 25%). For stage III, chemotherapy administration was highest in Belgium (44%) and lowest in Sweden (2%). Three year relative survival for stage I, II, and III disease in Belgium was 67.8% (95% CI:62.8-72.6), 41.2% (95% CI:37.3-45.2), 17.8% (95% CI:12.5-24.0), compared with 56.7% (95% CI:51.5-61.7), 31.3% (95% CI:27.6-35.2), 8.2% (95% CI:4.4-13.4) in Sweden. There were no significant differences in treatment strategies of patients with stage I disease. CONCLUSION Substantial treatment differences are observed across North European countries for patients with stages II and III resectable gastric cancer aged 70 years or older. In the present comparison, treatment strategies with a higher proportion of patients undergoing surgery seemed to be associated with higher survival rates for patients with stages II or III disease.
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Affiliation(s)
- Y H M Claassen
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - J L Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - W O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - M Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), the Netherlands
| | | | | | - J Johansson
- Department of Surgery, Lund University, Lund, Sweden
| | - I Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institute, Stockholm, Sweden; Section of Esophagogastric Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - E Johnson
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Gastroenterological and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - G O Hjortland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - L S Jensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - H J Larsson
- The Danish National Registries, a National Quality Improvement Programme (RKKP), Aarhus, Denmark
| | - W H Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, Great Britain, UK
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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25
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Schuurman MS, Kruitwagen RFPM, Portielje JEA, Roes EM, Lemmens VEPP, van der Aa MA. Treatment and outcome of elderly patients with advanced stage ovarian cancer: A nationwide analysis. Gynecol Oncol 2018. [PMID: 29514738 DOI: 10.1016/j.ygyno.2018.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To provide an overview of treatment strategies for elderly patients with advanced stage epithelial ovarian cancer (EOC) in daily practice, evaluate changes over time and relate this to surgical mortality and survival. METHODS All women diagnosed with advanced stage (FIGO IIB and higher) EOC between 2002 and 2013 were selected from the Netherlands Cancer Registry (n=10,440) and stratified by age, stage and period of diagnosis. Elderly patients were defined as aged ≥70years. Time trends in treatment patterns and postoperative mortality were described by age category and tested using multivariable logistic regression. Relative survival was calculated. RESULTS With advancing age, less patients received ((neo-)adjuvant) treatment. Over time, elderly patients were less often treated (OR 2002-2004 versus 2011-2013: 0.73; 95%CI:0.58-0.92). But if treated, more often standard treatment was provided and 30-day postoperative mortality decreased from 4.5% to 1.9% between 2005 and 2007 and 2011-2013. In all age categories treatment shifted from primary surgery towards primary chemotherapy, in patients aged 70-79years combination therapy increased (+5%) between 2002 and 2004 and 2011-2013. Five-year relative survival for patients diagnosed in 2008-2010 aged <70years was 34% compared to 18% for elderly patients. CONCLUSION Large treatment differences exist between younger and elderly patients. Over time, selection of elderly patients eligible for curative surgical treatment may have improved. More elderly patients were treated with neoadjuvant chemotherapy while less patients underwent surgery and simultaneously postoperative mortality decreased. However, the large and increasing number of elderly patients without treatment and the large survival gap suggests opportunities for further improvements in the care for elderly EOC patients.
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Affiliation(s)
- M S Schuurman
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - E M Roes
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - V E P P Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands; Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - M A van der Aa
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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26
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van Munster BC, Portielje JEA, Maier AB, Arends AJ, de Beer JJA. Methodology for senior-proof guidelines: A practice example from the Netherlands. J Eval Clin Pract 2018; 24:254-257. [PMID: 28322487 DOI: 10.1111/jep.12738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Evidence-based guidelines constitute a foundation for medical decision making. It is often unclear whether recommendations in general guidelines also apply to older people. This study aimed to develop a methodology to increase the focus on older people in the development of guidelines. METHODS The methodology distinguishes 4 groups of older people: (1) relatively healthy older people; (2) older people with 1 additional specific (interfering) comorbid condition; (3) older people with multimorbidity; and (4) vulnerable older people. RESULTS The level of focus on older people required may be determined by the prevalence of the disease or condition, level of suffering, social relevance, and the expectation that a guideline may improve the quality of care. A specialist in geriatric medicine may be involved in the guideline process via participation, provision of feedback on drafts, or involvement in the analysis of problem areas. Regarding the patient perspective, it is advised to involve organisations for older people or informal carers in the inventory of problem areas, and additionally to perform literature research of patient values on the subject. If the guideline focuses on older people, then the relative importance of the various outcome measures for this target group needs to be explicitly stated. Search strategies for all the 4 groups are suggested. For clinical studies that focus on the treatment of diseases that frequently occur in older people, a check should be made regarding whether these studies produce the required evidence. This can be achieved by verifying if there is sufficient representation of older people in the studies and determining if there is a separate reporting of results applying to this age group.
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Affiliation(s)
- Barbara C van Munster
- Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Johanna E A Portielje
- Department of internal medicine and oncology, Hagaziekenhuis, Den Haag, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.,Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arend J Arends
- Dutch Geriatrics Society (Dutch abbreviation: NVKG), Utrecht, The Netherlands.,Department of Geriatrics, Havenziekenhuis, Rotterdam, The Netherlands
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Abstract
Purpose of Review Breast cancer incidence increases with age. In recent years, primary endocrine therapy has been increasingly used as a treatment option for frail elderly women with breast cancer, although surgery is still the guideline-recommended treatment. In this review, we discuss the evidence for primary endocrine therapy versus surgical treatment in older women with early breast cancer. Recent Findings Both randomised controlled trials and recent observational studies showed a favourable progression-free survival but not overall survival for surgery plus adjuvant endocrine therapy versus primary endocrine therapy. Information about quality of life with either treatment strategy is so far lacking. Deciding who is fit for surgery and has sufficiently long life expectation to be at risk of disease progression can be supported by performing an individual geriatric assessment. Summary This review suggests that primary endocrine therapy is a reasonable alternative to primary surgery in frail older women with breast cancer. Future studies should focus on the long-term effects on quality of life and physical functioning.
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Affiliation(s)
- R M C Pepping
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.,Department of Clinical Oncology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - W van de Water
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - N A de Glas
- Department of Clinical Oncology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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28
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van den Broek CBM, Puylaert CCEM, Breugom AJ, Bastiaannet E, de Craen AJM, van de Velde CJH, Liefers GJ, Portielje JEA. Administration of adjuvant chemotherapy in older patients with Stage III colon cancer: an observational study. Colorectal Dis 2017; 19:O358-O364. [PMID: 28873267 DOI: 10.1111/codi.13876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023]
Abstract
AIM According to established guidelines, patients with Stage III colon cancer should receive adjuvant chemotherapy. However, a significant proportion do not. This study assessed factors associated with the administration of adjuvant chemotherapy and causes of death. METHODS Patients with Stage III colon cancer who underwent surgery between 2000 and 2009 were selected from two hospitals in the Netherlands. Patient characteristics including comorbidities and treatment preferences, tumour characteristics and follow-up were extracted from the medical records. The patient and tumour characteristics of patients who did receive chemotherapy were compared with those who did not using chi-squared analysis. Differences between the groups in causes of death were recorded together with the duration of follow-up. RESULTS A total of 348 patients were included. The median age was 73 years (range 33-93). Over half of the patients received adjuvant chemotherapy (50.6%). Patients who did not receive adjuvant chemotherapy were significantly older (P < 0.001), had more comorbidities (P < 0.001) and were more often living alone (P < 0.001). Patients who received no adjuvant chemotherapy had a reduced overall survival, and the cause of death was more often attributed to other causes (60%) than colon cancer (40%). For patients who received chemotherapy, the cause of death was usually attributed to colon cancer (71%). CONCLUSION Patients who did not receive adjuvant chemotherapy had a worse overall survival and the majority died due to other causes than colon cancer. In our aging society it will become even more important to develop tools to estimate remaining life expectancy in order to improve the selection of older patients for adjuvant treatments.
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Affiliation(s)
- C B M van den Broek
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - C C E M Puylaert
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A J Breugom
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - A J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - G-J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J E A Portielje
- Department of Clinical Oncology, HAGA Hospital, The Hague, The Netherlands
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29
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Cirkel GA, Hamberg P, Sleijfer S, Loosveld OJL, Dercksen MW, Los M, Polee MB, van den Berkmortel F, Aarts MJ, Beerepoot LV, Groenewegen G, Lolkema MP, Tascilar M, Portielje JEA, Peters FPJ, Klümpen HJ, van der Noort V, Haanen JBAG, Voest EE. Alternating Treatment With Pazopanib and Everolimus vs Continuous Pazopanib to Delay Disease Progression in Patients With Metastatic Clear Cell Renal Cell Cancer: The ROPETAR Randomized Clinical Trial. JAMA Oncol 2017; 3:501-508. [PMID: 27918762 DOI: 10.1001/jamaoncol.2016.5202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To our knowledge, this is the first randomized clinical trial evaluating an alternating treatment regimen in an attempt to delay disease progression in clear cell renal cell carcinoma. Objective To test our hypothesis that an 8-week rotating treatment schedule with pazopanib and everolimus delays disease progression, exhibits more favorable toxic effects, and improves quality of life when compared with continuous treatment with pazopanib. Design, Setting, and Participants This was an open-label, randomized (1:1) study (ROPETAR trial). In total, 101 patients with treatment-naive progressive metastatic clear cell renal cell carcinoma were enrolled between September 2012 and April 2014 from 17 large peripheral or academic hospitals in The Netherlands and followed for at least one year. Interventions First-line treatment consisted of either an 8-week alternating treatment schedule of pazopanib 800 mg/d and everolimus 10 mg/d (rotating arm) or continuous pazopanib 800 mg/d (control arm) until progression. After progression, patients made a final rotation to either pazopanib or everolimus monotherapy (rotating arm) or initiated everolimus (control arm). Main Outcome and Measures The primary end point was survival until first progression or death. Secondary end points included time to second progression or death, toxic effects, and quality of life. Results A total of 52 patients were randomized to the rotating arm (median [range] age, 65 [44-87] years) and 49 patients to the control arm (median [range] age, 67 [38-82] years). Memorial Sloan Kettering Cancer Center risk category was favorable in 26% of patients, intermediate in 58%, and poor in 15%. Baseline characteristics and risk categories were well balanced between arms. One-year PFS1 for rotating treatment was 45% (95% CI, 33-60) and 32% (95% CI, 21-49) for pazopanib (control). Median time until first progression or death for rotating treatment was 7.4 months (95% CI, 5.6-18.4) and 9.4 months (95% CI, 6.6-11.9) for pazopanib (control) (P = .37). Mucositis, anorexia, and dizziness were more prevalent in the rotating arm during first-line treatment. No difference in quality of life was observed. Conclusions and Relevance Rotating treatment did not result in prolonged progression-free-survival, fewer toxic effects, or improved quality of life. First-line treatment with a vascular endothelial growth factor inhibitor remains the optimal approach in metastatic clear cell renal cell carcinoma. Trial Registration clinicaltrials.gov Identifier: NCT01408004.
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Affiliation(s)
- Geert A Cirkel
- University Medical Center Utrecht, Department of Medical Oncology, Utrecht, the Netherlands
| | - Paul Hamberg
- Franciscus Gasthuis, Department of Medical Oncology, Rotterdam, the Netherlands
| | - Stefan Sleijfer
- Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, the Netherlands
| | - Olaf J L Loosveld
- Amphia Hospital, Department of Medical Oncology, Breda, the Netherlands
| | - M Wouter Dercksen
- Maxima Medical Center, Department of Medical Oncology, Eindhoven, the Netherlands
| | - Maartje Los
- St Antonius Hospital, Department of Medical Oncology, Nieuwegein, the Netherlands
| | - Marco B Polee
- Medical Center Leeuwarden, Department of Medical Oncology, Leeuwarden, the Netherlands
| | | | - Maureen J Aarts
- Maastricht University Medical Center, Department of Medical Oncology, Maastricht, the Netherlands
| | - Laurens V Beerepoot
- Elisabeth Tweesteden Hospital, Department of Medical Oncology, Tilburg, the Netherlands
| | - Gerard Groenewegen
- University Medical Center Utrecht, Department of Medical Oncology, Utrecht, the Netherlands
| | - Martijn P Lolkema
- University Medical Center Utrecht, Department of Medical Oncology, Utrecht, the Netherlands3Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, the Netherlands
| | - Metin Tascilar
- Isala Clinics, Department of Medical Oncology, Zwolle, the Netherlands
| | | | - Frank P J Peters
- Zuyderland Medical Center, Department of Medical Oncology, Sittard-Geleen, the Netherlands
| | - Heinz-Josef Klümpen
- Academic Medical Center, Department of Medical Oncology, Amsterdam, the Netherlands
| | | | - John B A G Haanen
- Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam, the Netherlands
| | - Emile E Voest
- University Medical Center Utrecht, Department of Medical Oncology, Utrecht, the Netherlands16Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam, the Netherlands
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van Rossum AGH, Oosterkamp HM, van Werkhoven E, Opdam M, Mandjes IAM, van Leeuwen-Stok E, van Tinteren H, Kok M, Imholz ALT, Portielje JEA, Bos MMEM, van Bochove A, Wesseling J, Rutgers EJ, Rodenhuis S, Linn SC. Abstract P5-14-03: Adjuvant dose dense doxorubicin-cyclophosphamide (ddAC) or docetaxel-AC (TAC) for high-risk breast cancer: First results of the randomized MATADOR trial (BOOG-2004-04). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-14-03] [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: 11/16/2022]
Abstract
Abstract
Background: Anthracycline-based adjuvant chemotherapy has substantially improved breast cancer survival. Both the addition of taxanes as well as using a dose dense treatment schedule can further ameliorate outcome, but inter-individual differences exist. Here we present the efficacy and toxicity of dose dense scheduled doxorubicin/cyclophosphamide (ddAC) versus docetaxel/doxorubicin/cyclophosphamide (TAC), which is, to our knowledge, the first direct comparison of these treatment regimens.
Methods: In this Dutch, multicenter phase III trial (ISRCTN61893718), patients with pT1-3, pN0-3, M0 breast cancer were randomized between six cycles of either A60C600 every 2 weeks or T75A50C500 every 3 weeks. All patients received pegfilgrastim. Patients were evaluated for recurrence-free survival (RFS) and overall survival (OS). Survival was compared in a Cox regression analysis and adjusted for known prognostic factors. These factors include age, type of surgery, tumor size, histological grade, ER/PR status, HER2 status, and lymph node status. Adverse events were reported according to the common toxicity criteria (CTCAE version 3.0).
Results: Between 2004 and 2012, 664 patients were enrolled of whom 531 (80%) had node positive disease. At a median follow up of 5 years, OS was 92% in the ddAC treated subgroup and 93% in the TAC treated subgroup (adjusted hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.42-1.34, intention to treat population). Forty-two breast-cancer specific deaths were equally divided over both treatment arms. Similarly, no significant difference in RFS was observed between both treatment groups (adjusted HR 0.85, 95% CI 0.55-1.32). Molecular subtypes were defined by St. Gallen criteria: 548 patients (83%) had estrogen receptor positive disease and 102 patients (15%) triple negative disease. No heterogeneity regarding treatment efficacy was observed in these subtypes. In particular, there was no survival benefit for ddAC or TAC in the triple negative subtype. Both treatment regimens were well tolerated. Whereas anemia was more frequent in ddAC treated patients (19% vs 4.7%; p<0.001), peripheral neuropathy occurred more frequently in TAC treated patients (4.6% vs 14.4%; p<0.001). The frequency of febrile neutropenia was not significantly different between the treatment arms (11% vs 12.5%; n.s.). Six patients developed congestive heart failure: 2 ddAC treated patients, 4 TAC treated patients. One ddAC treated patient and one TAC treated patient were diagnosed with acute myeloid leukemia after study treatment; another patient in the ddAC treatment group developed myelodysplastic syndrome.
Conclusions: At a median follow up of 5 years no significant survival differences were observed between adjuvant ddAC and TAC, in all patients and in molecular subgroups, including triple negative. Our findings are in line with the Oxford overview, which reported no significant differences between taxane-based chemotherapy and more, non-taxane based chemotherapy given in a dose dense schedule. ddAC could be a reasonable alternative for patients with a contra-indication for TAC.
Citation Format: van Rossum AGH, Oosterkamp HM, van Werkhoven E, Opdam M, Mandjes IAM, van Leeuwen-Stok E, van Tinteren H, Kok M, Imholz ALT, Portielje JEA, Bos MMEM, van Bochove A, Wesseling J, Rutgers EJ, Rodenhuis S, Linn SC. Adjuvant dose dense doxorubicin-cyclophosphamide (ddAC) or docetaxel-AC (TAC) for high-risk breast cancer: First results of the randomized MATADOR trial (BOOG-2004-04) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-14-03.
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Affiliation(s)
- AGH van Rossum
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - HM Oosterkamp
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - E van Werkhoven
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - M Opdam
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - IAM Mandjes
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - E van Leeuwen-Stok
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - H van Tinteren
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - M Kok
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - ALT Imholz
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - JEA Portielje
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - MMEM Bos
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - A van Bochove
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - J Wesseling
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - EJ Rutgers
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - S Rodenhuis
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
| | - SC Linn
- Netherlands Cancer Institute, Amsterdam, Netherlands; Medical Center Haaglanden-Bronovo, The Hague, Netherlands; BOOG Study Center, Amsterdam, Netherlands; Deventer Ziekenhuis, Deventer, Netherlands; HagaZiekenhuis, The Hague, Netherlands; Reinier de Graaf Gasthuis, Delft, Netherlands; Zaans Medical Center, Zaandam, Netherlands; University Medical Center, Utrecht, Netherlands
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31
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Frouws MA, Bastiaannet E, Langley RE, Chia WK, van Herk-Sukel MPP, Lemmens VEPP, Putter H, Hartgrink HH, Bonsing BA, Van de Velde CJH, Portielje JEA, Liefers GJ. Effect of low-dose aspirin use on survival of patients with gastrointestinal malignancies; an observational study. Br J Cancer 2017; 116:405-413. [PMID: 28072768 PMCID: PMC5294482 DOI: 10.1038/bjc.2016.425] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies suggested a relationship between aspirin use and mortality reduction. The mechanism for the effect of aspirin on cancer outcomes remains unclear. The aim of this study was to evaluate aspirin use and survival in patients with gastrointestinal tract cancer. METHODS Patients with gastrointestinal tract cancer diagnosed between 1998 and 2011 were included. The population-based Eindhoven Cancer Registry was linked to drug-dispensing data from the PHARMO Database Network. The association between aspirin use after diagnosis and overall survival was analysed using Cox regression models. RESULTS In total, 13 715 patients were diagnosed with gastrointestinal cancer. A total of 1008 patients were identified as aspirin users, and 8278 patients were identified as nonusers. The adjusted hazard ratio for aspirin users vs nonusers was 0.52 (95% CI 0.44-0.63). A significant association between aspirin use and survival was observed for patients with oesophageal, hepatobiliary and colorectal cancer. CONCLUSIONS Post-diagnosis use of aspirin in patients with gastrointestinal tract malignancies is associated with increased survival in cancers with different sites of origin and biology. This adds weight to the hypothesis that the anti-cancer effects of aspirin are not tumour-site specific and may be modulated through the tumour micro-environment.
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Affiliation(s)
- M A Frouws
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - E Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - R E Langley
- MRC Clinical Trials Unit, University College London, Institute of Clinical Trials and Methodology, Aviation House 125 Kingsway, London WC2B 6NH, UK
| | - W K Chia
- Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - M P P van Herk-Sukel
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30/40, Utrecht 3528 AE, The Netherlands
| | - V E P P Lemmens
- Comprehensive Cancer Organisation The Netherlands, Eindhoven 5600 AE, The Netherlands
- Department of Public Health, Erasmus MC Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - H Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - H H Hartgrink
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - B A Bonsing
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - C J H Van de Velde
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Haga Hospital, Leyweg 275, The Hague 2545 CH, The Netherlands
| | - G J Liefers
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
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32
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Meulendijks D, de Groot JWB, Los M, Boers JE, Beerepoot LV, Polee MB, Beeker A, Portielje JEA, Goey SH, de Jong RS, Vanhoutvin SALW, Kuiper M, Sikorska K, Pluim D, Beijnen JH, Schellens JHM, Grootscholten C, Tesselaar MET, Cats A. Bevacizumab combined with docetaxel, oxaliplatin, and capecitabine, followed by maintenance with capecitabine and bevacizumab, as first-line treatment of patients with advanced HER2-negative gastric cancer: A multicenter phase 2 study. Cancer 2016; 122:1434-43. [PMID: 26970343 DOI: 10.1002/cncr.29864] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 09/08/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The current study was a multicenter, single-arm, phase 2 study performed to investigate the feasibility and efficacy of bevacizumab combined with docetaxel, oxaliplatin, and capecitabine (B-DOC) in patients with advanced human epidermal growth factor receptor 2 (HER2)-negative, previously untreated, gastric or gastroesophageal adenocarcinoma. METHODS Tumor HER2 status was determined centrally. Patients received 6 cycles of bevacizumab at a dose of 7.5 mg/kg, docetaxel at a dose of 50 mg/m(2) , and oxaliplatin at a dose of 100 mg/m(2) (all on day 1) combined with capecitabine at a dose of 850 mg/m(2) twice daily (days 1-14) every 3 weeks followed by maintenance with capecitabine and bevacizumab in patients with disease control. The primary objective was to demonstrate a progression-free survival (PFS) of >6.5 months, according to the 95% confidence interval (95% CI). Secondary endpoints included safety, objective response rate, overall survival (OS), analyses of circulating tumor cells (CTCs), and pharmacogenetic analyses. RESULTS Sixty eligible patients were enrolled. The median PFS was 8.3 months (95% CI, 7.2-10.9 months). The objective response rate was 70% (95% CI, 55%-83%) and the disease control rate was 96% (95% CI, 85%-99%). The median OS was 12.0 months (95% CI, 10.2-16.1 months). According to CTC-AE v4.0, the most common treatment-related grade ≥3 adverse events were neutropenia (20%), leukocytopenia (18%), diarrhea (15%), and nausea/vomiting (15%). The presence of CTCs at baseline was strongly predictive of PFS (hazard ratio [HR], 3.8; P =.007) and OS (HR, 3.4; P =.014). The methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype was strongly associated with PFS (HR, 4.7 for TT vs CC or CT; P =.0007) and OS (HR, 5.9; P =.0001). CONCLUSIONS The B-DOC regimen plus maintenance was feasible and active. CTCs were found to be prognostic in patients treated with B-DOC. Docetaxel-based triplet chemotherapy as a backbone for targeted therapies is feasible and deserves further study. Cancer 2016;122:1434-1443. © 2016 American Cancer Society.
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Affiliation(s)
- Didier Meulendijks
- Division of Medical Oncology, Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maartje Los
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - James E Boers
- Department of Pathology, Isala, Zwolle, The Netherlands
| | | | - Marco B Polee
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Aart Beeker
- Department of Internal Medicine, Spaarne Hospital, Hoofddorp, The Netherlands
| | | | - Swan H Goey
- Department of Internal Medicine, Tweesteden Hospital, Tilburg, The Netherlands
| | - Robert S de Jong
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Steven A L W Vanhoutvin
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maria Kuiper
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dick Pluim
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan H M Schellens
- Division of Medical Oncology, Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Cecile Grootscholten
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Margot E T Tesselaar
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemieke Cats
- Division of Medical Oncology, Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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33
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de Glas NA, Bastiaannet E, Engels CC, de Craen AJM, Putter H, van de Velde CJH, Hurria A, Liefers GJ, Portielje JEA. Validity of the online PREDICT tool in older patients with breast cancer: a population-based study. Br J Cancer 2016; 114:395-400. [PMID: 26783995 PMCID: PMC4815772 DOI: 10.1038/bjc.2015.466] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Predicting breast cancer outcome in older patients is challenging, as it has been shown that the available tools are not accurate in older patients. The PREDICT tool may serve as an alternative tool, as it was developed in a cohort that included almost 1800 women aged 65 years or over. The aim of this study was to assess the validity of the online PREDICT tool in a population-based cohort of unselected older patients with breast cancer. Methods: Patients were included from the population-based FOCUS-cohort. Observed 5- and 10-year overall survival were estimated using the Kaplan–Meier method, and compared with predicted outcomes. Calibration was tested by composing calibration plots and Poisson Regression. Discriminatory accuracy was assessed by composing receiver-operator-curves and corresponding c-indices. Results: In all 2012 included patients, observed and predicted overall survival differed by 1.7%, 95% confidence interval (CI)=−0.3–3.7, for 5-year overall survival, and 4.5%, 95% CI=2.3–6.6, for 10-year overall survival. Poisson regression showed that 5-year overall survival did not significantly differ from the ideal line (standardised mortality ratio (SMR)=1.07, 95% CI=0.98–1.16, P=0.133), but 10-year overall survival was significantly different from the perfect calibration (SMR=1.12, 95% CI=1.05–1.20, P=0.0004). The c-index for 5-year overall survival was 0.73, 95% CI=0.70–0.75, and 0.74, 95% CI=0.72–0.76, for 10-year overall survival. Conclusions: PREDICT can accurately predict 5-year overall survival in older patients with breast cancer. Ten-year predicted overall survival was, however, slightly overestimated.
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Affiliation(s)
- N A de Glas
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands
| | - C C Engels
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands
| | - A J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands
| | - A Hurria
- Cancer and Ageing Research Program, City of Hope, 1500 E Duarte Road, Duarte, CA 91010, USA
| | - G J Liefers
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300RC Leiden, The Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Haga Hospital The Hague, Leyweg 275, 2545 CH Den Haag, The Netherlands
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34
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Meulendijks D, Beerepoot LV, Boot H, de Groot JWB, Los M, Boers JE, Vanhoutvin SALW, Polee MB, Beeker A, Portielje JEA, de Jong RS, Goey SH, Kuiper M, Sikorska K, Beijnen JH, Tesselaar ME, Schellens JHM, Cats A. Trastuzumab and bevacizumab combined with docetaxel, oxaliplatin and capecitabine as first-line treatment of advanced HER2-positive gastric cancer: a multicenter phase II study. Invest New Drugs 2015; 34:119-28. [PMID: 26643663 DOI: 10.1007/s10637-015-0309-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/11/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the efficacy of bevacizumab and trastuzumab combined with docetaxel, oxaliplatin, and capecitabine (B-DOCT) as first-line treatment of advanced human epidermal growth factor receptor 2 (HER2)-positive gastric cancer (GC). METHODS In this multicentre, single-arm, phase II study, tumor HER2 status was determined centrally prior to treatment. Patients with advanced HER2-positive adenocarcinoma of the stomach or gastroesophageal junction (immunohistochemistry 3+ or immunohistochemistry 2+/silver in-situ hybridization positive) were treated with six cycles of bevacizumab 7.5 mg/kg (day 1), docetaxel 50 mg/m(2) (day 1), oxaliplatin 100 mg/m(2) (day 1), capecitabine 850 mg/m(2) b.i.d. (days 1-14), and trastuzumab 6 mg/kg (day 1) every three weeks, followed by maintenance with bevacizumab, capecitabine, and trastuzumab until disease progression. The primary objective was to demonstrate an improvement of progression-free survival (PFS) to >7.6 months (observed in the ToGA trial) determined according to the lower limit of the 95 % confidence interval (CI). Secondary endpoints were safety, objective response rate (ORR), and overall survival (OS). RESULTS Twenty-five patients with HER2-positive tumors were treated with B-DOCT between March 2011 and September 2014. At a median follow-up of 17 months, median PFS was 10.8 months (95%CI: 9.0-NA), OS was 17.9 months (95%CI: 12.4-NA). One-year PFS and OS were 52 % and 79 %, respectively. The ORR was 74 % (95%CI: 52-90 %). Two patients became resectable during treatment with B-DOCT and achieved a pathological complete response. The most common treatment-related grade ≥ 3 adverse events were: neutropenia (16 %), diarrhoea (16 %), and hypertension (16 %). CONCLUSIONS B-DOCT is a safe and active combination in HER2-positive GC, supporting further investigations of DOC with HER2/vascular endothelial growth factor (VEGF) inhibition in HER2-positive GC.
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Affiliation(s)
- Didier Meulendijks
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Division of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | | | - Henk Boot
- Department of Gastroenterology and Hepatology, Division of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | | | - Maartje Los
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - James E Boers
- Department of Pathology, Isala, Zwolle, The Netherlands
| | - Steven A L W Vanhoutvin
- Department of Gastroenterology and Hepatology, Division of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marco B Polee
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Aart Beeker
- Department of Internal Medicine, Spaarne Hospital Hoofddorp, Hoofddorp, The Netherlands
| | | | - Robert S de Jong
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Swan H Goey
- Department of Internal Medicine, Tweesteden Hospital, Tilburg, The Netherlands
| | - Maria Kuiper
- Department of Gastroenterology and Hepatology, Division of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Margot E Tesselaar
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan H M Schellens
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Annemieke Cats
- Department of Gastroenterology and Hepatology, Division of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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35
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de Glas NA, Bastiaannet E, de Craen AJM, van de Velde CJH, Siesling S, Liefers GJ, Portielje JEA. Survival of older patients with metastasised breast cancer lags behind despite evolving treatment strategies--a population-based study. Eur J Cancer 2015; 51:310-6. [PMID: 25559617 DOI: 10.1016/j.ejca.2014.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 09/09/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older women are more likely to be diagnosed with primary metastasised breast cancer than their younger counterparts. Evolving treatment strategies of metastasised breast cancer have resulted in improved survival in younger patients, but it remains unclear if this improvement has occurred in older patients as well. The aim of this study was to assess changes in treatment strategies over time in relation to overall and relative survival of older patients compared to younger patients with primary metastasised breast cancer. METHODS All patients with a breast cancer diagnosis and distant metastases at first presentation (stage IV), between 1990 and 2012, were selected from the Netherlands Cancer Registry. Changes in treatment over time per age-group (<65 years, 65-75 years and >75 years) were assessed using logistic regression. Overall survival over time was calculated using Cox Regression Models and relative survival was assessed using the Ederer II method. RESULTS Overall, 14,310 patients were included. Treatment strategies have strongly changed in the past twenty years; especially the use of chemotherapy has increased (P<0.001 in all age-groups). Overall survival of patients <65 has significantly improved (Hazard Ratio (HR) per year 0.98, 95% Confidence Interval (CI) 0.98-0.99, P<0.001), but the survival of older patients has not improved (HR 1.00, 95% CI 0.99-1.01, P=0.86 for patients aged 65-75 and HR 1.00, 95% CI 1.00-1.01, P=0.46 for patients aged >75). Similarly, relative survival has improved in patients <65 but not in women aged 65-75 and >75. CONCLUSION Overall and relative survival of older patients with metastasised breast cancer at first presentation have not improved in recent years in contrast with the survival of younger patients, despite increased treatment with chemotherapy for women of all ages. Future studies should focus on stratification models that can be used to predict which patients may benefit from specific treatment options.
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Affiliation(s)
- N A de Glas
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - E Bastiaannet
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - A J M de Craen
- Leiden University Medical Center, Department of Gerontology & Geriatrics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - C J H van de Velde
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - S Siesling
- Comprehensive Cancer Centre the Netherlands, Department of Research, P.O. Box 19079, 3501 DB Utrecht, The Netherlands
| | - G J Liefers
- Leiden University Medical Center, Department of Surgery, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - J E A Portielje
- Haga Hospital The Hague, Department of Internal Medicine, Leyweg 275, 2545 CH Den Haag, The Netherlands.
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van der Geest LGM, Portielje JEA, Wouters MWJM, Weijl NI, Tanis BC, Tollenaar RAEM, Struikmans H, Nortier JWR. Complicated postoperative recovery increases omission, delay and discontinuation of adjuvant chemotherapy in patients with Stage III colon cancer. Colorectal Dis 2014; 15:e582-91. [PMID: 23679338 DOI: 10.1111/codi.12288] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 02/15/2013] [Indexed: 12/11/2022]
Abstract
AIM The study included investigation of factors determining suboptimal adjuvant chemotherapy of patients diagnosed with Stage III colon cancer. METHOD All 606 patients diagnosed with Stage III colon cancer between 2006 and 2008 in the western part of the Netherlands were included. Patient [gender, age, comorbidity and socio-economic status (SES)], tumour (location, stage and grade) and treatment (emergency surgery, laparoscopic surgery, reoperation, hospital stay and multidisciplinary meeting) factors were examined in logistic regression analyses predicting a complicated postoperative period and omission, delay and discontinuation of adjuvant chemotherapy. RESULTS Overall, 27% of all patients experienced a complicated postoperative period, which was independently associated with emergency surgery, older age, multiple comorbidity, male gender and poor tumour grade. Of patients who survived this period, 60% received chemotherapy. Chemotherapy was omitted more often in women, the elderly and in patients with Stage IIIB, reoperation, prolonged hospital stay and (borderline) after open surgery. Of patients who received chemotherapy, 86% started within 8 weeks after surgery. Patients with a higher SES, reoperation and prolonged hospital stay had a higher probability of a delayed start. Sixty-seven per cent of patients completed their chemotherapy. For women, elderly patients and patients with prolonged hospital stay a higher probability of discontinuation was noted. CONCLUSION Age was the most important predictive factor for receiving adjuvant chemotherapy. However, at all ages, complicated postoperative recovery negatively influenced the administration of chemotherapy to Stage III colon cancer patients, as well as a timely start and completion of chemotherapy.
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Affiliation(s)
- L G M van der Geest
- Comprehensive Cancer Centre The Netherlands (CCCNL), Utrecht, The Netherlands
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de Glas NA, Jonker JM, Bastiaannet E, de Craen AJM, van de Velde CJH, Siesling S, Liefers GJ, Portielje JEA, Hamaker ME. Impact of omission of surgery on survival of older patients with breast cancer. Br J Surg 2014; 101:1397-404. [DOI: 10.1002/bjs.9616] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/05/2014] [Accepted: 06/18/2014] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Older patients with breast cancer are often not treated in accordance with guidelines. With the emergence of endocrine therapy, omission of surgery can be considered in some patients. The aim of this population-based study was to investigate time trends in surgical treatment between 1995 and 2011, and to evaluate the effects of omitting surgery on overall and relative survival in older patients with resectable breast cancer.
Methods
Patients aged 75 years and older with stage I–III breast cancer diagnosed between 1995 and 2011 were selected from the Netherlands Cancer Registry. Time trends of all treatment modalities were evaluated using linear regression models. Changes in overall survival were calculated by Cox regression. Relative survival was calculated using the Ederer II method.
Results
Overall, 26 292 patients were included. The proportion of patients receiving surgical treatment decreased significantly, from 90·8 per cent in 1995 to 69·9 per cent in 2011 (P < 0·001). Multivariable analysis showed that overall survival did not change over time (hazard ratio 1·00 (95 per cent confidence interval (c.i.) 0·99 to 1·00) per year); nor did relative survival (relative excess risk 1·00 (0·98 to 1·02) per year).
Conclusion
Omission of surgery has become more common in older patients with breast cancer during the past 15 years in the Netherlands, but this has not altered overall or relative survival.
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Affiliation(s)
- N A de Glas
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - J M Jonker
- Department of Geriatric Medicine, Rijnland Ziekenhuis, Leiderdorp, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - A J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - S Siesling
- Department of Research, Comprehensive Cancer Centre, Utrecht, The Netherlands
- MIRA Institute of Technical Medicine and Biomedical Technology, University of Twente, Enschede, The Netherlands
| | - G-J Liefers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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de Groot S, Vreeswijk MPG, Smit VTHBM, Heijns JB, Imholz ALT, Kessels LW, Jager A, Los M, Weijl NI, Smorenburg CH, Portielje JEA, Liefers GJ, van de Velde CJH, Meershoek EM, van Leeuwen E, Fischer MJ, Kaptein AA, Putter H, Longo V, Nortier HWR, van der Hoeven KJM, Pijl H, Kroep JR. Abstract OT3-1-03: DIRECT: A phase II/III randomized trial with dietary restriction as an adjunct to neoadjuvant chemotherapy for HER2-negative breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot3-1-03] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Preclinical evidence shows that short-term fasting protects normal cells, while cancer cells are sensitized to chemotherapy. Furthermore, a specifically designed very low calorie, low amino acid substitution diet (“Fasting Mimicking Diet”, FMD) has similar effects on chemotherapy as short-term fasting. This trial evaluates the impact of FMD on tolerance to and efficacy of neoadjuvant chemotherapy in women with HER2-negative early breast cancer.
Trial design:
DIRECT is a Dutch, randomized, open-label multicenter phase II/III trial. Women receiving neoadjuvant TAC courses (docetaxel/adriamycin/cyclophosphamide; day 1, q 3 weeks with G-CSF support at day 2) will be randomized with or without FMD for 3 days prior to and the day of chemotherapy and 3 days prior to surgery.
Eligibility criteria:
Eligible women are WHO 0-2, age ≥18 years, HER2-negative, stage II or III breast cancer and adequate bone marrow, liver and renal function, BMI > 19kg/m2 and absence of diabetes mellitus.
Study endpoints:
The primary endpoints are grade III/IV toxicity (phase II) and the pathologic complete response rate (pCR) (phase III). Secondary endpoints are grade I/II toxicity, metabolic and inflammatory response to chemotherapy, DNA damage, apoptosis, immunology and nutrient sensing pathways in the tumor, biomarkers as single nucleotide polymorphisms, Ki67 and tumor stroma/ratio, patient's quality of life and (disease free) survival. Optional side studies include chemotherapy-induced DNA damage and nutrient sensing pathways in leukocytes and proteomics.
Statistical Methods:
Using a 5% significance level based on the two-sided Fisher's exact test with a power of 80%, 128 patients (64/arm) will be enrolled to show a 50% decrease of grade III/IV adverse events in the experimental arm (phase II) and 250 patients (125/arm) are needed to show an improvement of the pCR rate from 18% to 36% (phase III).
Target accrual:
Recruitment will start in September 2013. The expected end of accrual of 250 patients from multiple centers in the Netherlands will be the last quarter of 2015.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT3-1-03.
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Affiliation(s)
- S de Groot
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - MPG Vreeswijk
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - VTHBM Smit
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - JB Heijns
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - ALT Imholz
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - LW Kessels
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - A Jager
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - M Los
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - NI Weijl
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - CH Smorenburg
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - JEA Portielje
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - GJ Liefers
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - CJH van de Velde
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - EM Meershoek
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - E van Leeuwen
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - MJ Fischer
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - AA Kaptein
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - H Putter
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - V Longo
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - HWR Nortier
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - KJM van der Hoeven
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - H Pijl
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
| | - JR Kroep
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Deventer Hospital, Deventer, Netherlands; Erasmus Medical Center, Rotterdam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Bronovo Hospital, Den Haag, Netherlands; Medical Center Alkmaar, Alkmaar, Netherlands; Haga Hospital, Den Haag, Netherlands; Boog Study Center
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Kiderlen M, de Glas NA, Bastiaannet E, Engels CC, van de Water W, de Craen AJM, Portielje JEA, van de Velde CJH, Liefers GJ. Diabetes in relation to breast cancer relapse and all-cause mortality in elderly breast cancer patients: a FOCUS study analysis. Ann Oncol 2013; 24:3011-6. [PMID: 24026538 DOI: 10.1093/annonc/mdt367] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 12/29/2022] Open
Abstract
BACKGROUND In developed countries, 40% of breast cancer patients are >65 years of age at diagnosis, of whom 16% additionally suffer from diabetes. The aim of this study was to assess the impact of diabetes on relapse-free period (RFP) and overall mortality in elderly breast cancer patients. PATIENTS AND METHODS Patients were selected from the retrospective FOCUS cohort, which contains detailed information of elderly breast cancer patients. RFP was calculated using Fine and Gray competing risk regression models for patients with diabetes versus patients without diabetes. Overall survival was calculated by Cox regression models, in which patients were divided into four groups: no comorbidity, diabetes only, diabetes and other comorbidity or other comorbidity without diabetes. RESULTS Overall, 3124 patients with non-metastasized breast cancer were included. RFP was better for patients with diabetes compared with patients without diabetes (multivariable HR 0.77, 95% CI 0.59-1.01), irrespective of other comorbidity and most evident in patients aged ≥75 years (HR 0.67, 95% CI 0.45-0.98). The overall survival was similar for patients with diabetes only compared with patients without comorbidity (HR 0.86, 95% CI 0.45-0.98), while patients with diabetes and additional comorbidity had the worst overall survival (HR 1.70, 95% CI 1.44-2.01). CONCLUSION When taking competing mortality into account, RFP was better in elderly breast cancer patients with diabetes compared with patients without diabetes. Moreover, patients with diabetes without other comorbidity had a similar overall survival as patients without any comorbidity. Possibly, unfavourable effects of (complications of) diabetes on overall survival are counterbalanced by beneficial effects of metformin on the occurrence of breast cancer recurrences.
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Affiliation(s)
- M Kiderlen
- Department of Surgery, Leiden University Medical Center, Leiden
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Fontein DBY, de Glas NA, Duijm M, Bastiaannet E, Portielje JEA, Van de Velde CJH, Liefers GJ. Age and the effect of physical activity on breast cancer survival: A systematic review. Cancer Treat Rev 2013; 39:958-65. [PMID: 23608116 DOI: 10.1016/j.ctrv.2013.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 02/04/2013] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Abstract
The effect of physical activity (PA) on cancer survival is still the topic of debate in oncology research focusing on survivorship, and has been investigated retrospectively in several large clinical trials. PA has been shown to improve quality of life, fitness and strength, and to reduce depression and fatigue. At present, there is a growing body of evidence on the effects of PA interventions for cancer survivors on health outcomes. PA and functional limitations are interrelated in the elderly. However the relationship between breast cancer survival and PA in older breast cancer patients has not yet been fully investigated. Our systematic review of the existing literature on this topic yielded seventeen studies. Most reports demonstrated an improved overall and breast cancer-specific survival. Furthermore, in studies that compared younger women with older or postmenopausal women, it was suggested that the beneficial effect of PA may be even greater in older women. Understanding the interaction between physical functioning and cancer survival in older breast cancer patients is key, and may contribute to successful treatment and survival. In this population of cancer survivors it is therefore imperative to embark on research focused on improving physical functioning in the context of comorbidities and functional limitations.
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Affiliation(s)
- D B Y Fontein
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Smorenburg CH, Seynaeve C, Wymenga MANM, Maartense E, de Graaf H, de Jongh FE, Braun HJ, Los M, Schrama JG, Portielje JEA, Hamaker M, van Tinteren H, de Groot SM, van Leeuwen-Stok EAE, Nortier HWR. Abstract P1-12-05: First-line chemotherapy with pegylated liposomal doxorubicin versus capecitabine in elderly patients with metastatic breast cancer: results of the phase III OMEGA study of the Dutch Breast Cancer Trialists' Group (BOOG). Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-12-05] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background The efficacy and feasibility of chemotherapy in elderly metastatic breast cancer (MBC) patients (pts) have been studied in various phase II studies. However, results of prospective randomized studies in elderly MBC pts are scarce.
Methods In this phase III multicenter study, MBC pts ≥ 65 years eligible for first-line chemotherapy were randomized between pegylated liposomal doxorubicin (PEGdoxo) (45mg/m2, IV, q 4 wks) or capecitabine (Cape) (1000 mg/m2 PO bid, days 1–14, q 3 wks). Other eligibility criteria were ECOG performance status (PS) ≤ 2 (3 allowed if due to pain or pre existing comorbidity), adequate bone marrow and organ functions. Stratification factors were PS (0–1 vs 2–3), HER2 status, visceral/non-visceral disease, adjuvant hormonal therapy (HTx), and HTx for MBC. Baseline geriatric assessment (GA) included functional status, instrumental activities of daily living, cognition, mood, comorbidity, polypharmacy and nutritional status. Chemotherapy was continued for 24 wks in the absence of progressive disease (PD) or unacceptable toxicity. Primary endpoint was progression-free survival (PFS), secondary endpoints were response rate, overall survival (OS), toxicity (CTC criteria) and compliance.
Results Between April 2007 and August 2011, 78 pts were randomized to PEGdoxo (n = 40) or Cape (n = 38). The study was prematurely closed due to slow accrual and supply problems with PEGdoxo. Mean age was 74 years (range 65–86; 75+ 54%; 80+ 13%). Pt characteristics were balanced between the two arms: PS 0–1 77%, ER+ 68%, HER2+ 5%, visceral/non-visceral disease 76%/24%, adjuvant HTx 46%, HTx for MBC 56%, ≥ 3 metastatic sites 50%. Only 22 out of 75 pts with a baseline GA had no geriatric condition (29%), while 32 pts (43%) and 21 pts (28%) had one or ≥ 2 geriatric conditions, respectively. Chemotherapy was given for 6 months in 38%, with a mean dose intensity of 84% in both arms. Reasons for early treatment discontinuation were: PD (31%), toxicity (28%), pt withdrawal (3%). After a median follow up of 32 months, 74 pts had PD and 56 pts had died. The median PFS was 5.7 and 7.7 months with PEGdoxo and Cape (HR 0.68, 95% CI: 0.42–1.11, p = 0.12) and the median OS was 13.8 and 16.8 months, respectively (HR 0.84, 95% CI: 0.49–1.42, p = 0.51). Response was evaluable in 64 pts, with a partial response (PR) in 7 (21%) and 6 pts (19%), and stable disease in 21 (64%) and 17 pts (55%) for PEGdoxo and Cape, respectively. Toxicity was acceptable, mainly being grade 1–2, with for PEGdoxo/Cape grade 1 alopecia in 14/4 pts (grade 2 in 1 PEGdoxo pt), grade 3 fatigue in 5/5 pts, grade 3 HFS in 4/6 pts and grade 3 mucositis in 4/1 pts, respectively. Pts with ≥ 1 geriatric condition more frequently experienced grade 3–4 toxicity, after correcting for type of chemotherapy, age and PS (HR 2.24, 95% CI: 1.21–4.16). Pts aged 75+ had a twofold higher risk of dying, irrespective of treatment arm (HR 2.31, 95% CI: 1.31–4.07).
Conclusions First-line chemotherapy with either PEGdoxo or Cape was feasible in elderly MBC pts, with adequate dose intensity and acceptable toxicity, even in non-fit pts or pts aged 75+. Baseline GA correlated with toxicity.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-12-05.
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Affiliation(s)
- CH Smorenburg
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - C Seynaeve
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - MANM Wymenga
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - E Maartense
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - H de Graaf
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - FE de Jongh
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - HJ Braun
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - M Los
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - JG Schrama
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - JEA Portielje
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - M Hamaker
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - H van Tinteren
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - SM de Groot
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - EAE van Leeuwen-Stok
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | - HWR Nortier
- Medical Center Alkmaar, Alkmaar, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Ikazia Hospital, Rotterdam, Netherlands; Vlietland Hospital, Schiedam, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Spaarne Hospital, Hoofddorp, Netherlands; Haga Hospital, The Hague, Netherlands; Diaconessehuis, Utrecht, Netherlands; Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Amsterdam, Netherlands; Dutch Breast Cancer Trialists' Group BOOG, Amsterdam, Netherlands; Leiden University Medical Center, Leiden, Netherlands
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Lam SW, de Groot SM, Honkoop AH, Jager A, ten Tije AJ, Bos MMEM, Linn SC, van den BJ, Nortier JWR, Braun JJ, de Graaf H, Portielje JEA, Los M, Gooyer DD, van Tinteren H, Boven E. PD07-07: Combination of Paclitaxel and Bevacizumab without or with Capecitabine as First-Line Treatment of HER2−Negative Locally Recurrent or Metastatic Breast Cancer (LR/MBC): First Results from a Randomized, Multicenter, Open-Label, Phase II Study of the Dutch Breast Cancer Trialists' Group (BOOG). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-pd07-07] [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: 11/16/2022]
Abstract
Abstract
Background: First-line treatment of HER2−negative LR/MBC with paclitaxel (T) and bevacizumab (A) has demonstrated improved progression-free survival (PFS) and overall response rate (ORR) when compared with T alone (E2100). We determined whether addition of capecitabine (X) to AT is safe and would be better effective than AT in women with HER2−negative LR/MBC.
Methods: Eligibility criteria were age ≥18 & ≤75 years, measurable or non-measurable HER2−negative LR/MBC, ECOG PS 0–1 and no prior chemotherapy for LR/MBC. Patients were randomized in 1:1 ratio to receive AT (4-week cycle of T 90 mg/m2 on days 1, 8, 15 and A 10 mg/kg on days 1, 15 for 6 cycles, followed by A 15 mg/kg on day 1 given 3-weekly for subsequent cycles) or ATX (3-week cycle of T 90 mg/m2 on days 1, 8, A 15 mg/kg on day 1 and X 825 mg/m2 bid on days 1–14 for 8 cycles, followed by A 15 mg/kg on day 1 and X 825 mg/m2 bid on days 1–14 given 3-weekly for subsequent cycles). Treatment was discontinued at disease progression, unmanageable toxicity or withdrawal of consent. The primary endpoint was PFS. Secondary endpoints were overall survival, ORR, duration of response and toxicity. Efficacy was evaluated according to RECIST 1.0 and toxicity was assessed according to NCI CTCAE 3.0.
Results: From June 2007 till December 2010, 312 patients were recruited at 36 sites. The median age was 56 years (range 32–76). Among all patients, 52% had ECOG 0, 85% were hormone-receptor positive, 86% had measurable disease and 8% had bone-only metastases. These factors were well balanced between both arms. A total of 48% and 33% of patients, respectively, received prior hormonal therapy or radiotherapy for LR/MBC. At the data cut-off of 1st June 2011, the median follow-up duration was 23 months. 311 patients received at least one cycle of treatment and were evaluable for safety. The median number of treatment cycles in AT was 9 and in ATX was 11 (both 33 weeks). An ORR of ≥40% was reached in patients with measurable disease in both groups. The incidence of serious adverse events (SAEs) was 47% and 40% for AT and ATX, respectively, while that of treatment-related SAEs was 12% and 19%, respectively. Treatment-related deaths were 2% for AT and 2% for ATX. The overall rate of AEs grade 3 or 4 was similar in both arms as shown in Table 1, except for hand-foot syndrome grade 3 and neutropenia grade 3 in ATX. In addition, 6 patients with pulmonary embolism were reported in ATX.
Conclusions: ATX was well tolerable, although more patients experienced hand-foot syndrome grade 3 and thromboembolic events than patients treated with AT. The efficacy data will be presented at the meeting. Support: This study was supported by Roche.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD07-07.
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Affiliation(s)
- SW Lam
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - SM de Groot
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - AH Honkoop
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - A Jager
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - AJ ten Tije
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - MMEM Bos
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - SC Linn
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - Bosch J van den
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - JWR Nortier
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - JJ Braun
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - H de Graaf
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - JEA Portielje
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - M Los
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - DD Gooyer
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - H van Tinteren
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
| | - E Boven
- 1VU University Medical Center, Amsterdam, Netherlands; Comprehensive Cancer Centre the Netherlands, Netherlands; Isala Clinics, Zwolle, Netherlands; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, Netherlands; Tergooi Hospitals, Hilversum, Netherlands; Reinier de Graaf Hospital, Delft, Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Albert Schweitzer Hospital, Dordrecht, Netherlands; Leiden University Medical Center, Leiden, Netherlands; Vlietland Hospital, Schiedam, Netherlands; Medical Center Leeuwarden, Leeuwarden, Netherlands; Haga Hospital, The Hague, Netherlands; St. Antonius Hospital, Nieuwegein, Netherlands; Franciscus Hospital, Roosendaal, Netherlands
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Bastiaannet E, Liefers GJ, de Craen AJM, Kuppen PJK, van de Water W, Portielje JEA, van der Geest LGM, Janssen-Heijnen MLG, Dekkers OM, van de Velde CJH, Westendorp RGJ. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat 2010; 124:801-7. [PMID: 20428937 DOI: 10.1007/s10549-010-0898-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 04/12/2010] [Indexed: 10/19/2022]
Abstract
Breast cancer is the most common type of cancer in several parts of the world and the number of elderly patients is increasing. The aim of this study was to describe stage at diagnosis, treatment, and relative survival of elderly patients compared to younger patients in the Netherlands. Adult female patients with their first primary breast cancer diagnosed between 1995 and 2005 were selected. Stage, treatment, and relative survival were described for young and elderly (≥ 65 years) patients and within the cohort of elderly patients according to 5-year age groups. Overall, 127,805 patients were included. Elderly breast cancer patients were diagnosed with a higher stage of disease. Moreover, within the elderly differences in stage were observed. Elderly underwent less surgery (99.2-41.2%); elderly received hormonal treatment as monotherapy more frequently (0.8-47.3%); and less adjuvant systemic treatment (79-53%). Elderly breast cancer patients with breast cancer had a decreased relative survival. Although relative survival was lower in the elderly, the percentage of patients who die of their breast cancer less than 50% above age 75. In conclusion, the relative survival for the elderly is lower as compared to their younger counterparts while the percentage of deaths due to other causes increases with age. This could indicate that the patient selection is poor and fit patients could suffer from "under treatment". In the future, specific geriatric screening tools are necessary to identify fit elderly patients who could receive more "aggressive" treatment while best supportive care should be given to frail elderly patients.
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Affiliation(s)
- E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, Leiden, RC, The Netherlands.
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Portielje JEA, Kruit WHJ, Eerenberg AJM, Schuler M, Sparreboom A, Lamers CHJ, Gratama JW, Stoter G, Huber C, Hack CE. Subcutaneous injection of interleukin 12 induces systemic inflammatory responses in humans: implications for the use of IL-12 as vaccine adjuvant. Cancer Immunol Immunother 2005; 54:37-43. [PMID: 15693137 PMCID: PMC11032940 DOI: 10.1007/s00262-004-0574-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 03/15/2004] [Accepted: 05/30/2004] [Indexed: 11/29/2022]
Abstract
Interleukin 12 (IL-12) is a cytokine with important regulatory functions bridging innate and adaptive immunity. It has been proposed as an immune adjuvant for vaccination therapy of infectious diseases and malignancies. The inflammatory properties of IL-12 play an important role in the adjuvant effect. We studied the effect of s.c. injections of recombinant human IL-12 (rHuIL-12) in 26 patients with renal cell cancer and demonstrated dose-dependent systemic activation of multiple inflammatory mediator systems in humans. rHuIL-12 at a dose of 0.5 microg/kg induced degranulation of neutrophils with a significant increase in the plasma levels of elastase (p < 0.05) and lactoferrin (p = 0.01) at 24 h. Additionally, rHuIL-12 injection mediated the release of lipid mediators, as demonstrated by a sharp increase in the plasma secretory phospholipase A2 (sPLA2) level (p = 0.003). rHuIL-12, when administered at a dose of 0.1 microg/kg, showed minimal systemic effects. In conclusion, when IL-12 is used as an adjuvant, doses should not exceed 0.1 microg/kg, in order to avoid severe systemic inflammatory responses.
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Affiliation(s)
- Johanna E. A. Portielje
- Department of Medical Oncology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - Wim H. J. Kruit
- Department of Medical Oncology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - Anke J. M. Eerenberg
- Department of Immunopathology, CLB Sanquin Foundation, Amsterdam, The Netherlands
| | - Martin Schuler
- Department of Medicine III, Johannes Gutenberg University, Mainz, Germany
| | - Alex Sparreboom
- Department of Medical Oncology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - Cor H. J. Lamers
- Department of Medical and Tumor Immunology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Jan-Willem Gratama
- Department of Medical and Tumor Immunology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Gerrit Stoter
- Department of Medical Oncology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - Christoph Huber
- Department of Medicine III, Johannes Gutenberg University, Mainz, Germany
| | - C. Erik Hack
- Department of Immunopathology, CLB Sanquin Foundation, Amsterdam, The Netherlands
- VU Medical Center, Amsterdam, The Netherlands
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Portielje JEA, Gratama JW, van Ojik HH, Stoter G, Kruit WHJ. IL-12: a promising adjuvant for cancer vaccination. Cancer Immunol Immunother 2003; 52:133-44. [PMID: 12649742 PMCID: PMC11033015 DOI: 10.1007/s00262-002-0356-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [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: 08/15/2002] [Accepted: 10/10/2002] [Indexed: 11/25/2022]
Abstract
The clinical development of interleukin 12 (IL-12) as a single agent for systemic cancer therapy has been hindered by its significant toxicity and disappointing anti-tumor effects. The lack of efficacy was accompanied by, and probably related to, the declining biological effects of IL-12 in the course of repeated administrations at doses approaching the maximum tolerated dose (MTD). Nevertheless, IL-12 remains a very promising immunotherapeutic agent because recent cancer vaccination studies in animal models and humans have demonstrated its powerful adjuvant properties. Therefore, IL-12 may re-enter the arena of cancer therapy. Here, we review the immune modulating characteristics of IL-12 considered responsible for the adjuvant effects, as well as the results of animal and human cancer vaccination studies with IL-12 applied as an adjuvant. In addition, we discuss how studies with systemic IL-12 in cancer patients, and several other lines of evidence, indicate that IL-12 may exert optimal adjuvant effects only at low dose levels. Therefore, the MTD may not constitute the maximum effective dose of IL-12 for adjuvant application.
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Affiliation(s)
- Johanna E A Portielje
- Department of Medical Oncology, Erasmus Medical Center, Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
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Portielje JEA, Lamers CHJ, Kruit WHJ, Sparreboom A, Bolhuis RLH, Stoter G, Huber C, Gratama JW. Repeated administrations of interleukin (IL)-12 are associated with persistently elevated plasma levels of IL-10 and declining IFN-gamma, tumor necrosis factor-alpha, IL-6, and IL-8 responses. Clin Cancer Res 2003; 9:76-83. [PMID: 12538454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
PURPOSE Repeated administrations of recombinant human interleukin-12 (rHuIL-12) to cancer patients are characterized by a reduction of side effects during treatment. Induction of IFN-gamma, considered a key mediator of antitumor effects of IL-12, is known to decline on repeated administrations. We studied whether other immunological effects of rHuIL-12 are tapered in the course of treatment. EXPERIMENTAL DESIGN In a Phase I study of 26 patients with advanced renal cell cancer, rHuIL-12 was administered s.c. on day 1, followed by 7 days rest and six injections administered over a 2-week time period. Plasma concentrations of various cytokines were monitored, as well as absolute counts of circulating leukocyte and lymphocyte subsets. RESULTS The first injection of IL-12 was accompanied by rapid, transient, and dose-dependent increments of plasma levels IFN-gamma, tumor necrosis factor-alpha, IL-10, IL-6, IL-8, but not IL-4, as well as rapid, transient, and dose-dependent reductions of lymphocyte, monocyte, and neutrophil counts. The major lymphocyte subsets, i.e., CD4+ and CD8+ T cells, B cells, and natural killer cells, followed this pattern. On repeated rHuIL-12 injections, IL-10 concentrations increased further, whereas the transient increments of IFN-gamma, tumor necrosis factor-alpha, IL-6, and IL-8 concentrations, as well as the fluctuations of the leukocyte subset counts, were tapered. Dose escalation of IL-12 within clinically tolerable margins did not reduce the decline of these immunological effects. CONCLUSIONS Induction of pro-inflammatory cytokines and associated fluctuations in leukocyte subset counts decrease on repeated administrations of rHuIL-12. The steady increment of IL-10 plasma levels may mediate the observed down-regulation of clinical and immunological effects.
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Affiliation(s)
- Johanna E A Portielje
- Department of Medical Oncology, Erasmus MC - Daniel den Hoed, 3075 EA Rotterdam, the Netherlands
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