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

Debled, Marc; Bellera, Carine; Donamaria, C.; Soubeyran, Pierre

doi:10.1016/j.ctrv.2011.04.007

Cited by 8 publications

(13 citation statements)

References 53 publications

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Section: Discussionmentioning

confidence: 99%

“…Previous studies on palliative chemotherapy in elderly patients with MBC lacked very elderly patients (age > 75 years), while including only relatively fit elderly . Debled et al have stated that the cut‐off point of 75 year, as used in our study, might be more appropriate for trials on treatment of the elderly patients due to the sharp increase in age‐related pharmacological changes and frailty. Likewise, a French retrospective study on treatment decisions in elderly patients with MBC showed that there was an evident decrease in prescription of chemotherapy in patients aged older than 76.5 years …”

Section: Discussionmentioning

confidence: 99%

“…Although chemotherapy may result in toxicity, its use also may benefit patients by relieving or delaying symptoms of disease and prolonging survival. Knowledge on the feasibility of palliative chemotherapy in this category of patients could prevent under treatment, but studies in elderly patients with MBC are rare and most are not randomized including only highly selected and relatively fit patients rarely age 75 or older …”

Section: Introductionmentioning

confidence: 94%

“…Knowledge on the feasibility of palliative chemotherapy in this category of patients could prevent under treatment, but studies in elderly patients with MBC are rare and most are not randomized including only highly selected and relatively fit patients rarely age 75 or older. 5,6 To gain knowledge on the feasibility of chemotherapy in very elderly women with MBC, we performed this retrospective cohort study in patients age 75 years or older who received first-line chemotherapy for MBC in two different hospitals. Our aim was to describe the efficacy and feasibility of palliative chemotherapy in very elderly patients in daily practice.…”

Section: Introductionmentioning

confidence: 99%

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Outcome and feasibility of palliative chemotherapy in very elderly patients with metastatic breast cancer

et al. 2020

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In the Netherlands, approximately 1300 women aged ≥75 years die every year of metastatic breast cancer (MBC). Data on palliative chemotherapy (CT) in very elderly patients are rare, and prospective studies appeared cumbersome. Therefore, we retrospectively analyzed the outcome and feasibility of chemotherapy in elderly MBC patients. Records of all patients with MBC aged ≥75 years who received first‐line palliative chemotherapy between January 2000 and December 2014 at two large teaching hospitals in the Netherlands were reviewed. We registered patient and tumor characteristics together with data on previous adjuvant treatment, palliative endocrine treatment, comorbidities, clinical benefit (defined as ≥6 months progression‐free survival), toxicity, and the reason for stopping chemotherapy. Patients with progressive disease (PD) or death within 30 days after starting CT were censored from analysis. A total of 54 patients with a median age of 77.6 years (range 75‐90) were treated with palliative chemotherapy for MBC. Of them, 20 patients (37%) were aged ≥ 80 years. There was clinical benefit in 28 patients (52%). Median progression‐free survival and median overall survival were 6.0 and 14.0 months, respectively. One year after the diagnosis of MBC, 27 patients (50%) were still alive and 15 patients (28%) lived longer than 2 years. Reasons for stopping CT were progressive disease (n = 32) or toxicity (n = 13). Most patients (n = 48) died of MBC while two patients died of toxicity. In selected patients with MBC aged 75 years or older, single‐agent palliative chemotherapy is feasible and may have clinical benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcome and feasibility of palliative chemotherapy in very elderly patients with metastatic breast cancer

et al. 2020

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“…71 Two studies that compared weekly with every-3-week paclitaxel administration showed similar response rates in all age-groups, but grade 3 and higher toxicity was linearly increased with age, especially hematologic toxicities, anorexia, bilirubin elevation, and neurotoxicity. 67,75 For octogenarians with HER2-positive tumors, trastuzumab alone can be considered, 76 although the risks of cardiac toxicity are higher than in younger patients. 19 Dose reductions, omissions, and grade 3 and higher toxicity were not age related.…”

Section: Metastatic Diseasementioning

confidence: 99%

Breast Cancer in Women Older Than 80 Years

Shachar

Hurria

Muss

2016

JOP

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Breast cancer is the most common cancer in women, with an incidence that rises dramatically with age. The average age at diagnosis of breast cancer is 61 years, and the majority of woman who die of breast cancer are age 65 years and older. Major improvements in public health and medical care have resulted in dramatic increases in longevity. The oldest old (those age 80 years and older) are a rapidly expanding group and now comprise 9 million members of the US population. The treatment of individuals who are age 80 years and older is complex and involves clearly defining the goals and value of treatment while also weighing risks, such as the potential effects of treatment on functional loss and quality of life. Limited evidence-based treatment guidelines exist for the caring of this older cohort of patients with breast cancer. Data from clinical trials that enroll primarily younger patients lack the information needed to estimate the likelihood of toxicities that can be life changing in older adults. Clinicians who make treatment recommendations should place the available evidence in the context of the patient's life expectancy and geriatric assessment results that include an evaluation of a patient's functional status, comorbidities, cognition, social support, nutritional status, and psychological state. Furthermore, these decisions should be placed in the context of the patient's goals for treatment, preferences, and values. This review summarizes the current literature and focuses on the role of geriatric assessment in treatment recommendations for patients age 80 years and older with early and metastatic breast cancer.

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Methodology of phase II clinical trials in metastatic elderly breast cancer: a literature review

Mourey

Balardy

Kanoun

et al. 2017

Breast Cancer Res Treat

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Only five studies evaluated the feasibility, i.e., to jointly assess efficacy and tolerance to treatment (toxicity, quality of life, etc) as primary endpoint. Development of elderly specific phase III clinical trials might be challenging, it therefore seems essential to conduct phase II clinical trials evaluating jointly efficacy and toxicity in a well-defined geriatric population. Use of multistage designs that take into account heterogeneity would allow to identify a subpopulation at interim analysis and to reduce the number of patients exposed to an inefficient or a toxic treatment regimen. It is crucial to evaluate new therapies (targeted therapies, immunotherapies) using adequate methodologies (Study design, endpoint).

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

Cited by 8 publications

References 53 publications

Outcome and feasibility of palliative chemotherapy in very elderly patients with metastatic breast cancer

Outcome and feasibility of palliative chemotherapy in very elderly patients with metastatic breast cancer

Breast Cancer in Women Older Than 80 Years

Methodology of phase II clinical trials in metastatic elderly breast cancer: a literature review

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