Dealing with metastatic breast cancer in elderly women: results from a French study on a large cohort carried out by the ‘Observatory on Elderly Patients’

Freyer, Gilles; Braud, Anne-Chantal; Chaïbi, P.; Spielmann, M.; Martin, Jeno; Vilela, Giovana Moutinho; Guérin, Daniel; Zelek, Laurent

doi:10.1093/annonc/mdj043

Cited by 65 publications

(46 citation statements)

References 25 publications

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“…While the process for treating MBC in younger women is relatively well defined, there is little evaluation of prognostic factors influencing survival in MBC involving a large number of elderly patients. Treatment choice seems to be arbitrarily based on a subjective evaluation by physicians [17]. …”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in 401 Elderly Women with Metastatic Breast Cancer

Follana

Barrière²,

Chamorey³

et al. 2014

Oncology

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Background: Elderly patients with metastatic breast cancer have a prognosis and outcome that may be dependent on a host of factors. Patients and Methods: We retrospectively analyzed 401female breast cancer patients who developed metastatic disease after the age of 70 years in order to define potential prognostic factors for specific survival at the time of first recurrence. Results: With a median follow-up of 60 months from the time of recurrence, the median specific survival was 21.0 months (95% CI 17.0-23.0). In multivariate analysis we demonstrated that negative hormonal receptor status (p = 0.002), presence of positive lymph nodes at initial cancer diagnosis (hazard ratio, HR = 1.37; 95% CI 1.07-1.75; p = 0.01), site of metastasis (p < 10^-4) and metastasis-free interval (HR = 0.99; 95% CI 0.95-0.99; p = 0.008) constituted unfavorable independent prognostic factors able to predict specific survival from the time of metastatic occurrence. Age at initial diagnosis, Scarff-Bloom Richardson grade and adjuvant treatments were significant only in univariate analysis. Conclusion: These survival prognostic factors associated with the use of a specific geriatric questionnaire to assess frailty may assist physicians in evaluating the patient's survival potential and choose a tailored treatment to this cancer population.

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Section: Introductionmentioning

confidence: 99%

Prognostic Factors in 401 Elderly Women with Metastatic Breast Cancer

Follana

Barrière²,

Chamorey³

et al. 2014

Oncology

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“…Freyer et al reported the pattern of treatment in patients with metastatic breast cancer in France whose age C 65. They reported selection of BSC was not affected by the age (65-74 vs. C75) and selection of endocrine therapy rather than chemotherapy was significantly affected by age, as we revealed [2]. Hamberg et al summarized response rate of chemotherapy in patients with metastatic breast cancer aged C65 [20].…”

Section: Discussionmentioning

confidence: 50%

“…Elderly patients with advanced breast cancer are not often managed according to treatment guidelines, since a standard of care for the elderly has not yet been established [1]. The treatment of elderly patients, therefore, is generally modified to account for considerations of age and the subjective evaluation of the patient's general status [2].…”

Section: Introductionmentioning

confidence: 99%

A retrospective study of the impact of age on patterns of care for elderly patients with metastatic breast cancer

et al. 2010

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This study aims at evaluating the impact of age on patterns of care in elderly patients with metastatic breast cancer (MBC) and their outcome. We identified 177 patients aged ≥ 65 treated for MBC at the National Cancer Center Hospital in Japan from 1999 to 2007. We evaluated the impact of age on the selection of best supportive care (BSC) only, chemotherapy as first-line treatment, and chemotherapy after first-line endocrine therapy. Fisher's exact test and a multivariate logistic regression analysis with variables of age, performance status (PS), hormone receptor (HR) status, human epidermal growth factor-2 (HER2), and life-threatening disease (LTD) were used. The median age of patients was 72, and 60 patients (33.9%) were aged ≥ 75. HR-negative patients and those whose PS was ≥ 2, regardless of age, were more likely to choose BSC without chemotherapy. Multivariate analysis revealed age ≥ 75 (P = 0.018), positive-HR status (P < 0.001), and absence of LTD (P < 0.001) were significantly correlated to choose endocrine therapy rather than chemotherapy. In patients who had previous endocrine therapy, age (P = 0.008) and absence of HER2 (P = 0.018) were related not to choose chemotherapy. Not age but HR-negative status or PS ≥ 2 were related to the selection of BSC. In selecting endocrine therapy rather than chemotherapy, age (≥ 75), HR-positive, and absence of LTD were significant factors. In patients failed to endocrine therapy, age and HER2 status were correlated to decision-making to choose chemotherapy.

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“…However, this less aggressive background of breast cancer in elderly patients is not necessarily reflected in survival, since the cause-specific mortality rate from breast cancer is reported to be highest in patients aged C75 years old. However, these data may be affected by natural survival and the incidence of complications [14], as well as undertreatment and the discovery of breast cancer in an advanced stage in many elderly patients [15,16].…”

Section: Biological Characteristics Of Breast Cancer In Elderly Patientsmentioning

confidence: 99%

Comprehensive geriatric assessment in elderly breast cancer patients

et al. 2009

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Treatment of elderly patients with breast cancer is limited by the lack of evidence-based medicine due to exclusion of elderly persons from clinical studies and the difficulty of decision-making in an elderly population comprising subjects with heterogeneous health backgrounds. Individual variation of health conditions is larger in elderly patients than in young people. Since the risk-benefit balance of treatment depends on the health background, judgment of the vulnerability of individual patients is required in treatment planning. The comprehensive geriatric assessment (CGA) is a tool for acquisition of information for design of a cancer treatment plan based on evaluation of the vulnerability of elderly patients from various perspectives. The domains of the CGA include physical function, comorbidity, cognitive function, psychological status, social support system, nutrition, and medication. The CGA can be used to predict survival and adverse events; to identify health problems that cannot be detected based on medical history or examination; to recognize new problems that emerge during course observation; and to improve psychological conditions. However, application of the CGA in routine clinical practice requires establishment of a consensus regarding the survey method, evaluation scale, and use of results in decision-making. A prospective investigation of the CGA as an outcome index in elderly breast cancer patients is required to address these issues.

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Dealing with metastatic breast cancer in elderly women: results from a French study on a large cohort carried out by the ‘Observatory on Elderly Patients’

Abstract: Inclusion of elderly patients with MBC in prospective trials is warranted to define standards of care and reduce heterogeneity in the decision-making process.

Cited by 65 publications

References 25 publications

Prognostic Factors in 401 Elderly Women with Metastatic Breast Cancer

Prognostic Factors in 401 Elderly Women with Metastatic Breast Cancer

A retrospective study of the impact of age on patterns of care for elderly patients with metastatic breast cancer

Comprehensive geriatric assessment in elderly breast cancer patients

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