Adjuvant Treatment of Elderly Breast Cancer Patients: Offer the Best Chances of Cure

Breast Care ◽  
2021 ◽  
pp. 1-10
Author(s):  
Spyridon Marinopoulos ◽  
Constantine Dimitrakakis ◽  
Andreas Kalampalikis ◽  
Flora Zagouri ◽  
Angeliki Andrikopoulou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Imaging Techniques ◽  
Performance Status ◽  
Poor Performance ◽  
Standard Of Care ◽  
The Elderly ◽  
Poor Performance Status ◽  
Breast Cancer Patients ◽  
Prompt Diagnosis ◽  
Made In

Background: Breast cancer remains the most common cancer in women and a leading cause of death. Elderly people have a higher incidence of breast cancer since it increases with age. Furthermore, the extended life expectancy and advances in imaging techniques have led to an increased number of cases. Guidelines concerning the management of this specific age group are rare, mainly due to underrepresentation of seniors in clinical trials. Moreover, increased frailty, comorbidities, and a poor performance status make it complex to determine the best therapeutic approach. Summary: In this review, we attempt to summarize the current literature and aim to provide specific approaches and recommendations for prompt diagnosis, treatment, and management of breast cancer in the elderly. Key Messages: The establishment of applicable protocols is imperative and efforts are being made in this direction. A careful geriatric assessment and adequate consultation should be the standard of care and patient’s preferences should always be considered.

scholarly journals Impact of Undetected Comorbidity on Treatment and Outcomes of Breast Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Robert I. Griffiths ◽  
Michelle L. Gleeson ◽  
José M. Valderas ◽  
Mark D. Danese
Keyword(s):  
Breast Cancer ◽  
Performance Status ◽  
Poor Performance ◽  
Index Score ◽  
Poor Performance Status ◽  
Chronic Obstructive ◽  
Breast Cancer Patients ◽  
Obstructive Pulmonary Disease ◽  
Multivariable Analyses ◽  
After Cancer

Preexisting comorbidity adversely impacts breast cancer treatment and outcomes. We examined the incremental impact of comorbidity undetected until cancer. We followed breast cancer patients in SEER-Medicare from 12 months before to 84 months after diagnosis. Two comorbidity indices were constructed: the National Cancer Institute index, using 12 months of claims before cancer, and a second index for previously undetected conditions, using three months after cancer. Conditions present in the first were excluded from the second. Overall, 6,184 (10.1%) had≥1undetected comorbidity. Chronic obstructive pulmonary disease (38%) was the most common undetected condition. In multivariable analyses that adjusted for comorbidity detected before cancer, older age, later stage, higher grade, and poor performance status all were associated with higher odds of≥1undetected comorbidity. In stage I–III cancer, undetected comorbidity was associated with lower adjusted odds of receiving adjuvant chemotherapy (Odds Ratio (OR) = 0.81, 95% Confidence Interval (CI) 0.73–0.90,P<0.0001;OR=0.38, 95% CI 0.30–0.49,P<0.0001; index score 1 or≥2, respectively), and with increased mortality (Hazard Ratio (HR) = 1.45, 95% CI 1.38–1.53,P<0.0001;HR=2.38, 95% CI 2.18–2.60,P<0.0001; index score 1 or≥2). Undetected comorbidity is associated with less aggressive treatment and higher mortality in breast cancer.

Weekly Epirubicin in Advanced Breast Cancer

1988 ◽  
Vol 74 (6) ◽  
pp. 689-692 ◽  
Author(s):  
Enrico Tucci ◽  
Renato Algeri ◽  
Alfredo Guarnieri ◽  
Fiorella Pepi ◽  
Lidia Sapio ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Performance Status ◽  
Poor Performance ◽  
Cytotoxic Chemotherapy ◽  
Advanced Breast ◽  
Poor Performance Status ◽  
Weekly Schedule ◽  
Breast Cancer Patients ◽  
Duration Of Response

Twenty-nine advanced breast cancer patients, considered unable to tolerate conventional cytotoxic chemotherapy, were treated with a weekly schedule of epirubicin (15 mg/m2 i.v.). All patients were fully evaluable. A remission of 34.5 % was observed (2 CR; 8 PR), with a median duration of response of 9 months (range, 3–24 months). Side effects were mild, and on the whole the toxicity was negligible. This regimen showed a favorable therapeutic ratio in our series and seems active and well tolerated even in elderly and/or poor performance status patients.

Weekly Docetaxel in the Treatment of Elderly Patients With Advanced Breast Cancer: A Minnie Pearl Cancer Research Network Phase II Trial

2001 ◽  
Vol 19 (15) ◽  
pp. 3500-3505 ◽  
Author(s):  
John D. Hainsworth ◽  
Howard A. Burris ◽  
Denise A. Yardley ◽  
James E. Bradof ◽  
Manuel Grimaldi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Advanced Breast Cancer ◽  
Performance Status ◽  
Metastatic Breast ◽  
Poor Performance ◽  
Advanced Breast ◽  
Poor Performance Status ◽  
Line Treatment ◽  
Weekly Docetaxel

PURPOSE: To evaluate the efficacy and toxicity of docetaxel administered weekly to elderly or poor-performance status patients with advanced breast cancer. PATIENTS AND METHODS: Forty-one patients with advanced breast cancer who were either over the age of 65 or considered to be poor candidates for combination chemotherapy received docetaxel 36 mg/m2 weekly for 6 consecutive weeks, followed by 2 weeks without treatment. The median age of patients in this trial was 74 years, and 73% of patients had one or more visceral sites of metastases. Seventy-five percent of patients received weekly docetaxel as first-line treatment for metastatic breast cancer, and the other 25% received it as second-line treatment. Thirty-six patients were assessable for efficacy, and all patients were assessed for toxicity. RESULTS: A total of 448 doses of weekly docetaxel were administered to 41 patients. Thirteen patients (36%) had objective responses to treatment, and an additional 13 patients (36%) had stable disease or minor response. Median time to progression for responding and stable patients was 7 months (range, 3 to 27 months). Median survival for the entire group was 13 months, with 1- and 2-year actuarial survival rates of 61% and 29%, respectively. Severe neutropenia occurred in only 0.4% of courses, and no other hematologic toxicity was observed. Grade 3/4 fatigue was the most common toxicity, occurring in 20% of patients. CONCLUSION: Weekly docetaxel therapy is active and well tolerated by elderly and/or poor-performance status patients with advanced breast cancer. This treatment can be administered with minimal myelosuppression. Weekly docetaxel provides an additional option for treatment in this difficult subgroup of patients with metastatic breast cancer. Well-tolerated combination regimens containing weekly docetaxel merit evaluation for this patient population.

scholarly journals Age and acute myeloid leukemia

Blood ◽  
2006 ◽  
Vol 107 (9) ◽  
pp. 3481-3485 ◽  
Author(s):  
Frederick R. Appelbaum ◽  
Holly Gundacker ◽  
David R. Head ◽  
Marilyn L. Slovak ◽  
Cheryl L. Willman ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Group Treatment ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
Poor Performance ◽  
The Elderly ◽  
Lower Percentage ◽  
Poor Performance Status ◽  
Cell Counts ◽  
Acute Myeloid

We conducted a retrospective analysis of 968 adults with acute myeloid leukemia (AML) on 5 recent Southwest Oncology Group trials to understand how the nature of AML changes with age. Older study patients with AML presented with poorer performance status, lower white blood cell counts, and a lower percentage of marrow blasts. Multidrug resistance was found in 33% of AMLs in patients younger than age 56 compared with 57% in patients older than 75. The percentage of patients with favorable cytogenetics dropped from 17% in those younger than age 56 to 4% in those older than 75. In contrast, the proportion of patients with unfavorable cytogenetics increased from 35% in those younger than age 56 to 51% in patients older than 75. Particularly striking were the increases in abnormalities of chromosomes 5, 7, and 17 among the elderly. The increased incidence of unfavorable cytogenetics contributed to their poorer outcome, and, within each cytogenetic risk group, treatment outcome deteriorated markedly with age. Finally, the combination of a poor performance status and advanced age identified a group of patients with a very high likelihood of dying within 30 days of initiating induction therapy. The distinct biology and clinical responses seen argue for age-specific assessments when evaluating therapies for AML.

The role of systemic treatment after whole brain radiotherapy (WBRT) in breast cancer patients with brain metastases: Differences depending on biological subtype

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1027-1027
Author(s):  
A. Niwinska ◽  
M. Murawska ◽  
I. Lemanska ◽  
J. Milewska
Keyword(s):  
Breast Cancer ◽  
Brain Metastases ◽  
Median Survival ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Systemic Treatment ◽  
Performance Status ◽  
Poor Performance Status ◽  
Breast Cancer Patients ◽  
Her 2

1027 Background: The aim of the study was to analyze the efficacy of systemic treatment (chemotherapy [chth], endocrine therapy, targeted therapy) performed after WBRT in patients (pts) with breast cancer and brain metastases. Methods: The group of 222 consecutive breast cancer pts with brain metastases treated in one institution in the years 2003–2006 was divided into four biological subgroups based on ER, PR, and HER-2 receptors’ expression: HER-2(+++)ER/PR(-); HER-2(+++)ER/PR(+); ER(-)PR(-)HER-2(-); and ER/PR(+)HER-2(-). WBRT was performed in 219 (99%) pts. Systemic therapy after WBRT was continued in 160 (72%) pts. Clinically, patients with triple-negative breast cancer were more often in poor performance status (KPS<60%) than the others (51% vs. 28%, respectively). Survivals from brain metastases without and with systemic treatment were compared in four mentioned biological subgroups. Results: Median survival from brain metastases in the entire group was 7.5 months. In the group of ER/PR(+)HER-2(-) median survival without and with systemic therapy was 3 and 14 months, respectively (p = 0.007). In the group of HER-2(+++)ER/PR(+) median survival without further treatment, after chth and after chth with trastuzumab was 2, 8, and 13 months, respectively (p = 0.000) and in the group of HER-2(+++)ER/PR(-) median survival without further treatment, after chth and after chth with trastuzumab was 4, 8, and 10 months, respectively (p = 0.004). In triple-negative breast cancer patients median survival without and with chemotherapy was 3 and 4 months, respectively (p = 0.75). Conclusions: Systemic treatment (chth, endocrine therapy, targeted therapy) continued after WBRT in breast cancer pts with brain metastases prolongs survival in three of four biological subgroups. In the group of HER-2-positive breast cancer pts, trastuzumab added to chth had independent positive impact on survival. No benefit was observed in the subgroup of triple-negative breast cancer pts; it would be the result of refractory disease and the fact, that more pts were in poor performance status. No significant financial relationships to disclose.

A randomized trial in postmenopausal patients with advanced breast cancer comparing endocrine and cytotoxic therapy given sequentially or in combination. The Australian and New Zealand Breast Cancer Trials Group, Clinical Oncological Society of Australia.

1986 ◽  
Vol 4 (2) ◽  
pp. 186-193 ◽  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Endocrine Therapy ◽  
Performance Status ◽  
Poor Performance ◽  
Advanced Breast ◽  
Poor Performance Status ◽  
Cytotoxic Therapy ◽  
Disease Free Interval ◽  
Single Modality

A prospective randomized clinical trial was performed in 339 postmenopausal patients with advanced breast cancer. Two single modality treatment sequences, doxorubicin plus cyclophosphamide (AC) followed on failure by tamoxifen (TAM), and TAM followed by AC, were compared with combined modality chemo-endocrine therapy (TAM plus AC). The response rate to initial TAM (22.1%) was inferior to that for AC (45.1%), and for TAM plus AC (51.3%). However, patients randomized to the sequence TAM followed by AC showed a 42.5% overall tumor response to sequential protocol therapy, similar to the 46.9% for those randomized to AC followed by TAM. Furthermore, survival in all three arms was almost identical. Adverse prognostic factors for survival were liver metastases, short disease-free interval, poor performance status, and prior adjuvant chemotherapy. In no subgroup was significantly better survival associated with initial cytotoxic therapy. Endocrine therapy followed on failure by cytotoxics is appropriate for postmenopausal patients with advanced breast cancer.

Use of gemcitabine-platinum (Gem-P) in patients with advanced gall bladder (GB) cancer: A more aggressive disease compared to the West—Tata Memorial Centre (TMC) experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 349-349
Author(s):  
Bhawna Sirohi ◽  
Vipul Sheth ◽  
Ashish Singh ◽  
Alok Gupta ◽  
Mahesh Goel ◽  
...  
Keyword(s):  
Clinical Benefit ◽  
Performance Status ◽  
Poor Performance ◽  
Standard Of Care ◽  
Median Number ◽  
Best Supportive Care ◽  
Poor Performance Status ◽  
The West ◽  
Clinical Benefit Rate ◽  
Northern India

349 Background: GB cancer is a common cancer in northern India. Gem-P is currently the standard of care for pts with advanced biliary tract cancers based on the ABC02 study which had 61 pts with GB cancer with a clinical benefit rate (CR+PR+SD) of 85%. Indian patients have a higher risk disease and present at a more advanced stage than in the West and data on treatment is lacking. Methods: This is retrospective analysis of the prospectively maintained database of 131 pts with advanced GB cancer treated at TMC between Jan 2012-May 2013. Aim of the study is to assess the clinical benefit rate in this group of pts with the Gem-P. Pts received cisplatin 25 mg/m2 and gemcitabine 1000 mg/m2 on D1 and D8 of a 21day cycle, for gem-oxaliplatin, pts received gemcitabine 1000mg/m2 on D1 and oxaliplatin 100mg/m2 on D2 every 14 days. Response was assessed after 3-4 cycles. Results: Of the 131 patients, 110 pts were treated with Gem-P (95 oxaliplatin, 15 cisplatin; 1 received cetuximab-Gem-P) and 21 (16%) pts received best supportive care alone in view of poor performance status and deranged organ function. Median age was 53 years (range, 27-76), 82F/49 M; median CA19.9 206 (<2-2251660); median CEA 6.9 (0.8-3541); site of metastases was liver in 66 (50%), nodal in 74(56%), peritoneal in 29(22%) and bilateral ovarian in 5(3.8%) patients. Of the 110 pts treated with GEM-P, PS was 0-1 in 91% of patients; median number of cycles received was 4 (1-12); grade 3 &4 toxicities were- thrombocytpenia-12 (11%), neutropenia -2 (2%), hepatitis -2 (2%) patients, neuropathy-4 (4%) and diarrhea-8 (7.2%). 86/110 (78%) were evaluable for response out of which 4 (5%) had CR, 31(36%) had PR, 13(15%) had SD, and 38 (44%) had progressive disease. 32/110 (29%) pts received 2nd-line chemotherapy (majority capecitabine -irinotecan based). Conclusions: This is the single largest study to show tolerance and efficacy of Gem-P in Indian pts with advanced GB cancer. Compared to the ABC 02 study, the clinical benefit rate is low at 56% suggesting that the biology of advanced GB cancers in Indian pts is likely to be aggressive and needs to be studied in prospectively designed studies.

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