Chemotherapy treatment for older women with metastatic breast cancer: What is the evidence?

Background: The treatment of luminal metastatic breast cancer is based on endocrine therapy and chemotherapy treatment is limited to the progression of this treatment. Materials & methods: We analyzed the efficacy of treatment with bevacizumab plus paclitaxel in 43 patients with hormone receptor-positive and HER2-negative metastatic breast cancer. Discussion: Paclitaxel plus bevacizumab combination is a useful treatment in metastatic luminal breast cancer with an impressive overall survival of 31 months, similar to combination to endocrine therapy and targeted therapy in first line. In patients with hormone resistance, endocrine therapy saw worse results thus the taxol plus bevacizumab combination could be a better option. This combination does not influence the results of subsequent treatments; therefore, it could provide a good option for patients.

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Circulating tumour markers and time to progression in the chemotherapy treatment of metastatic breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10674 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10674-10674

Author(s):

M. Ruiz-Lopez-tejada ◽

L. Tejedor-Cabrera ◽

C. Iradi-Martinez

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Disease Control ◽

Prospective Trial ◽

Metastatic Breast ◽

Tumour Markers ◽

Chemotherapy Treatment ◽

Biological Behaviour ◽

Kaplan Meier ◽

Biological Patterns

10674 Background: Monitoring the response to the chemotherapy treatment (CT) in metastatic breast cancer (MBC) by circulating tumour markers (CTM) remains under investigation. We have previosly shown that early lack of biological progression of 4 CTM (1 oncofetal: CEA, 2 mucin related: CA 15.3,CA 549 and cytokeratin 18–19: TPA), predicts anatomic disease control - concordance nearly 100% for every CTM- during CT of MBC (E.J.C. Suppl Oct 2005, Vol 3 Abst 415- ECCO 13). The aim is to evaluate whether the biological behaviour predicts time till progression (TTP), as reliable parameter of the quality of response (QR). Methods: In 106 consecutive courses of different schedules of CT given along 3 years in our Hospital to 55 patients with progressive MBC, we conducted a prospective trial analysing these 4 CTM every 3 weeks before CT infusions and performing CTM concentration / time curves. TTP was calculated by Kaplan Meier method -SPSS 11-. Bio kinetic change has been defined as a lineal slope that includes 2 early and consecutive changes of at least 25% of CTM start value. The analysis covered 604 cycles, 405 curves and 2417 marker determinations. Results: Ninety six per cent of the cases have progressed after their CT courses. In CTM expressing diseases, and sometimes after a no more than 3 weeks paradoxical period, three biological patterns could be detected according to directional possibilities: progressive elevation (Bio P), progressive download (Bio R) and stabilization -without bio kinetic change- (Bio S). Table shows the TTP median values in the different group of cases with the same CTM Bio response patterns; Biological Patterns and TTP Kaplan Meier curves will be shown as a Poster at the meeting. Conclusions: In CTM expressing tumours and taking into account simple kinetics criteria, the dynamic analysis of CTM before infusions can early estimates TTP, adding complemmentary information to the disease control prediction in the evaluation of the QR during the CT of MBC. [Table: see text] No significant financial relationships to disclose.

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Cost-effectiveness of HER2 testing and trastuzumab therapy for metastatic breast cancer (MBC) patients in Sweden

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.1088 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 1088-1088

Author(s):

M. Lidgren ◽

C. Rehnberg ◽

N. Wilking ◽

B. Jönsson

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Cost Effectiveness ◽

Treatment Strategies ◽

Metastatic Breast ◽

Chemotherapy Treatment ◽

Her2 Testing ◽

Trastuzumab Treatment ◽

Life Years ◽

The Cost

1088 Background: Trastuzumab is a monoclonal antibody that together with chemotherapy significantly improves time to progression and overall survival for MBC patients with tumours overexpressing HER2. The aim of this study was to analyse the cost- effectiveness of HER2 testing and trastuzumab in combination with chemotherapy compared with chemotherapy alone from a societal perspective in a Swedish setting. Methods: We used a Markov state transition model to simulate HER2 testing and subsequent treatment in a hypothetical cohort of 65 year old metastatic breast cancer patients based on the study by Marty et al (Marty et al, J Clin Oncol. Jul 1 2005;23(19):4265–4274). Outcomes included life-time costs, quality adjusted life years (QALY), and cost per QALY gained. Five different testing and treatment strategies were evaluated. Results: We estimated the cost per QALY gained to be about 485,000 SEK (approximately 70,000 USD) and the cost per life year (LY) gained to be about 332,000 SEK (approximately 47,000 USD) for the strategy of IHC testing for all patients, with FISH confirmation of 2+ and 3+, and trastuzumab and chemotherapy treatment for FISH positive patients. For the strategy of FISH testing for all patients, with trastuzumab and chemotherapy for FISH positive patients, we estimated the cost per QALY gained to about 561,000 SEK (approximately 80,000 USD) and the cost per LY gained to be 384,000 SEK (approximately 55,000 USD). The remaining testing and treatment strategies were dominated. Results were sensitive to changes in the quality adjustment of life years with metastatic disease, the risk of breast cancer related death, and test characteristics. Conclusions: Our analysis indicate that the present Swedish guidelines of IHC testing for all patients with metastatic breast cancer, with FISH confirmation of 2+ and 3+, followed by trastuzumab and chemotherapy treatment for FISH positive patients is a cost-effective treatment option. However, further research on budget impact of trastuzumab treatment and patient accessibility to trastuzumab treatment is needed. No significant financial relationships to disclose.

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Treatment delays in older women with nonmetastatic breast cancer treated at minority-serving hospitals.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.122 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 122-122

Author(s):

Julia Song ◽

Elizabeth A. Mittendorf ◽

Tari A. King ◽

Christina Ahn Minami

Keyword(s):

Breast Cancer ◽

Native American ◽

Metastatic Breast Cancer ◽

Older Women ◽

Metastatic Breast ◽

Treatment Delay ◽

Treatment Delays ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

122 Background: Almost 60% of breast cancer in the U.S. occur in women aged >65, but these women are less likely to receive guideline-concordant care. Given existing treatment disparities by race/ethnicity, older minority women may be especially prone to potential gaps in breast cancer care. Hospitals serving higher proportions of minority patients are at risk to deliver suboptimal care, but how site of care impacts aging patients with breast cancer is not well defined. We sought to evaluate the association between race/ethnicity and breast cancer treatment delays in older women treated at minority-serving hospitals (MSH) vs non-MSHs. Methods: Women >65 years old with non-metastatic breast cancer diagnosed from 2010-2017 were identified in the National Cancer Database using data from Commission on Cancer (CoC)-accredited hospitals. Treatment delay was defined as >90 days from diagnosis to first treatment (surgery, chemotherapy, endocrine therapy). MSHs were defined as the top decile of hospitals serving predominantly Black or Hispanic patients. Multivariable logistic regression models adjusted for patient, disease, and hospital characteristics were used to determine the odds of treatment delay for women at MSHs vs non-MSHs across racial/ethnic groups. Results: 529,128 women (84.5% non-Hispanic White, 3.3% Hispanic White, 9.6% non-Hispanic Black, 0.1% Hispanic Black, 0.2% Native American, 2.5% Asian/Pacific Islander) were identified among 41 MSHs and 1,146 non-MSHs. Overall, time to treatment was <90 days in >95% of women (mean 33.4 days; standard deviation 26.4 days). Older women regardless of race at MSHs were more likely to suffer treatment delays than those at non-MSHs (odds ratio 1.31; 95% confidence interval 1.22-1.41). Compared to non-Hispanic White women, all minority groups had a higher likelihood of treatment delay regardless of MSH status (Table). Conclusions: Although most older women with non-metastatic breast cancer treated at CoC hospitals received care in a timely fashion, minorities and those treated at MSHs were more likely to experience treatment delays. Effective interventions addressing barriers to timely care at MSHs and among racial/ethnic minorities are needed. [Table: see text]

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