Individualizing Surveillance Mammography for Older Patients After Treatment for Early-Stage Breast Cancer

Purpose A phase III trial (Cancer and Leukemia Group B CALGB-49907) was conducted to test whether older patients with early-stage breast cancer would have equivalent relapse-free and overall survival with capecitabine compared with standard chemotherapy. The quality of life (QoL) substudy tested whether capecitabine treatment would be associated with a better QoL than standard chemotherapy. Patients and Methods QoL was assessed in 350 patients randomly assigned to either standard chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF] or doxorubicin and cyclophosphamide [AC]; n = 182) or capecitabine (n = 168). Patients were interviewed by telephone before treatment (baseline), midtreatment, within 1 month post-treatment, and at 12, 18, and 24 months postbaseline by using questionnaires from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30), a breast systemic adverse effects scale (EORTC BR23), and the Hospital Anxiety and Depression Scale (HADS). Results Compared with patients who were treated with standard chemotherapy, patients who were treated with capecitabine had significantly better QoL, role function, and social function, fewer systemic adverse effects, less psychological distress, and less fatigue during and at the completion of treatment (P ≤ .005). Capecitabine treatment was associated with less nausea, vomiting, and constipation and with better appetite than standard treatment (P ≤ .004), but worse hand-foot syndrome and diarrhea (P < .005). These differences all resolved by 12 months. Conclusion Standard chemotherapy was superior to capecitabine in improving relapse-free and overall survival for older women with early-stage breast cancer. Although capecitabine was associated with better QoL during treatment, QoL was similar for both groups at 1 year. The brief period of poorer QoL with standard treatment is a modest price to pay for a chance at improved survival.

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Duration and Toxicity of Adjuvant Trastuzumab in Older Patients With Early-Stage Breast Cancer: A Population-Based Study

Journal of Clinical Oncology ◽

10.1200/jco.2013.51.1261 ◽

2014 ◽

Vol 32 (9) ◽

pp. 927-934 ◽

Cited By ~ 52

Author(s):

Ines Vaz-Luis ◽

Nancy L. Keating ◽

Nancy U. Lin ◽

Huichuan Lii ◽

Eric P. Winer ◽

...

Keyword(s):

Breast Cancer ◽

Older Women ◽

Older Patients ◽

Early Stage ◽

Treatment Completion ◽

Early Stage Breast Cancer ◽

Cardiac Events ◽

Adjuvant Trastuzumab ◽

Comorbidity Score ◽

Days Of Therapy

Purpose Few data are available regarding adjuvant trastuzumab use in older women with early-stage breast cancer. We examined rates and predictors of adjuvant trastuzumab completion and cardiac events in this population. Patients and Methods We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify patients age ≥ 66 years with stage I to III breast cancer diagnosed between 2005 and 2009 who received trastuzumab. Completion of trastuzumab was defined as receipt of more than 270 days of therapy. We used multivariable logistic regression to examine patient, clinical, and geographic characteristics associated with trastuzumab completion. We also examined rates of hospital admissions for cardiac events. Results Among 2,028 women, most (71.2%) were younger than age 76 years and had a comorbidity score of 0 (66.8%); 85.2% received trastuzumab with chemotherapy. Overall, 1,656 women (81.7%) completed trastuzumab. Older patients and those with more comorbidity had lower odds of treatment completion (odds ratio [OR], 0.40 [95% CI, 0.30 to 0.55] for age ≥ 80 years v age 66 to 70 years; OR, 0.65 [95% CI, 0.49 to 0.88] for comorbidity score of 2 v 0). During treatment, 73 patients (3.6%) were hospitalized for cardiac events (2.6% of those who completed trastuzumab v 8.1% of those who did not; P < .001). Conclusion Most older patients who initiated adjuvant trastuzumab completed therapy. Age and comorbidity were among factors that were associated with treatment completion, and rates of significant cardiac events were higher in those who did not complete therapy. Further exploration of toxicities and optimal treatments for older women with human epidermal growth factor receptor 2–positive breast cancer are warranted.

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Evaluating the association between adjuvant chemotherapy and function-related adverse events among older patients with early stage breast cancer

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2017.05.005 ◽

2017 ◽

Vol 8 (4) ◽

pp. 242-248 ◽

Cited By ~ 3

Author(s):

Caroline Mariano ◽

Jennifer L. Lund ◽

Sharon Peacock Hinton ◽

Phyo Htoo ◽

Hyman Muss ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Adverse Events ◽

Older Patients ◽

Early Stage ◽

Early Stage Breast Cancer ◽

And Function

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Management Strategies for Older Patients with Low-Risk Early-Stage Breast Cancer: A Physician Survey

Current Oncology ◽

10.3390/curroncol29010001 ◽

2021 ◽

Vol 29 (1) ◽

pp. 1-13

Author(s):

Mashari Alzahrani ◽

Mark Clemons ◽

Lynn Chang ◽

Lisa Vendermeer ◽

Angel Arnaout ◽

...

Keyword(s):

Breast Cancer ◽

Older Patients ◽

Early Stage ◽

Histological Grade ◽

Management Strategies ◽

Disease Free Survival ◽

Low Risk ◽

Early Stage Breast Cancer ◽

Hormone Receptor Positive ◽

Definition Of

When managing older patients with lower-risk hormone-receptor-positive (HR+), HER2 negative (HER2−) early-stage breast cancer (EBC), the harms and benefits of adjuvant therapies should be taken into consideration. A survey was conducted among Canadian oncologists on the definitions of “low risk” and “older”, practice patterns, and future trial designs. We contacted 254 physicians and 21% completed the survey (50/242). Most respondents (68%, 34/50) agreed with the definition of “low risk” HR+/HER2− EBC being node-negative and either: ≤3 cm and low histological grade, ≤2 cm and intermediate grade, or ≤1 cm and high grade. The most popular chronological and biological age definition for older patients was ≥70 (45%, 22/49; 45% 21/47). In patients ≥ 70 with low risk EBC, most radiation and medical oncologists would recommend post-lumpectomy radiotherapy (RT) and endocrine therapy (ET). Seventy-eight percent (38/49) felt that trials are needed to evaluate RT and ET’s role in patients ≥ 70. The favored design was ET alone, vs. RT plus ET (39%, 15/38). The preferred primary and secondary endpoints were disease-free survival and quality of life, respectively. Although oncologists recommended both RT and ET, there is interest in performing de-escalation trials in patients ≥ 70.

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