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Li CJ, Gong SM, Shi YJ, Guo YN, Song NN, Jiang LM, Wang YY, Zhang CJ, Wang YB, Li ZP, Wang P, Ruan YH, Shi Z, Li HY, Zhang QJ, Fu WP. Application of comprehensive geriatric assessment in oncology nursing: A literature review on optimizing treatment decisions and patient outcomes. World J Clin Oncol 2025; 16:104785. [DOI: 10.5306/wjco.v16.i4.104785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/23/2025] [Accepted: 03/10/2025] [Indexed: 03/26/2025] Open
Abstract
With the global population aging, the care of elderly cancer patients has become increasingly complex and significant. Comprehensive geriatric assessment (CGA), a multidimensional evaluation tool, has been widely implemented in oncology nursing to enhance the precision of treatment decisions and improve patient outcomes. This review examines the application of CGA in oncology nursing, drawing on literature published between 2010 and 2024 in major databases using keywords such as “Comprehensive Geriatric Assessment” and “Oncology Nursing”. It highlights how CGA contributes to optimizing treatment selection, monitoring the treatment process, and improving patients’ quality of life and long-term outcomes. CGA provides a comprehensive evaluation of elderly cancer patients, including physical, psychological, and social aspects, enabling the identification of high-risk patients and reducing treatment-related side effects and complications. It also offers a critical foundation for developing personalized care plans. The article discusses various practical examples of CGA implementation across different countries and regions, including multidisciplinary collaborative models in France, the United States, and Australia, demonstrating CGA’s flexible application in diverse healthcare settings. Although significant progress has been made in applying CGA in oncology nursing, numerous challenges remain in its implementation, such as resource limitations and insufficient personnel training. Future research will focus on integrating CGA with emerging technologies, such as artificial intelligence and precision medicine, to further improve the quality of care and treatment outcomes for elderly cancer patients. By summarizing the current status and challenges of CGA in oncology nursing, this review provides guidance for future research and clinical practice, emphasizing the importance of advancing CGA application to meet the growing demands of elderly oncology care.
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Affiliation(s)
- Cheng-Jin Li
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Shu-Mei Gong
- Director of Medical Association Construction and Management Office, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yu-Juan Shi
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ya-Nan Guo
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Na-Na Song
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Li-Min Jiang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yan-Yan Wang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Henan Key Laboratory for Helicobacter pylori and Digestive Tract Microecology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Chang-Jiang Zhang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yao-Bin Wang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhi-Peng Li
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Tianjian Advanced Biomedical Laboratory, Zhengzhou University, Zhengzhou 450001, Henan Province, China
| | - Peng Wang
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yu-Hua Ruan
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhen Shi
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Hao-Yu Li
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Qiu-Jun Zhang
- Department of the Nursing, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Wei-Ping Fu
- Second Department of Orthopedics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Carmona-Gonzalez CA, Kumar S, Menjak IB. Current approaches to the pharmacological management of metastatic breast cancer in older women. Expert Opin Pharmacother 2024; 25:1785-1794. [PMID: 39279590 DOI: 10.1080/14656566.2024.2402022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 09/04/2024] [Indexed: 09/18/2024]
Abstract
INTRODUCTION A substantial majority of patients diagnosed with metastatic breast cancer consists of individuals 65-year-old or above. Emerging treatment approaches, which utilize genomics-guided therapy and innovative biomarkers, are currently in development. Given the numerous choices in the metastatic context, it is necessary to adopt a personalized approach to decision-making for these patients. AREAS COVERED The authors provide a comprehensive analysis of the existing literature on the use of systemic anticancer treatments in older women, specifically those aged 65 and above, who have metastatic breast cancer, focusing on the reported effectiveness and adverse effects of these treatments in this population. EXPERT OPINION The evidence to treat older patients with metastatic breast cancer primarily relies on subgroup analyses, whose interpretation should be approached with caution. In several clinical trials subgroup analysis, it has been observed that this population seem to have comparable benefits and toxicities to younger patients, but real-world data have showed older women exhibit worse rates of survival compared to younger women. Multiple factors are likely involved in this, but we postulate this is related to lower rates of guideline concordant, and factors such as comorbidity, lack of social supports, malnutrition, and geriatric factors like frailty and/or vulnerability. This underscores the importance of a broader assessment for patients with a geriatric perspective and involvement of multi-disciplinary team.
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Affiliation(s)
- Carlos A Carmona-Gonzalez
- Division of Medical Oncology, Department of Medicine, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sudhir Kumar
- Division of Medical Oncology, Department of Medicine, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Ines B Menjak
- Division of Medical Oncology, Department of Medicine, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Ontario, Canada
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Sanchez DN, Derks MGM, Verstijnen JA, Menges D, Portielje JEA, Van den Bos F, Bastiaannet E. Frequency of use and characterization of frailty assessments in observational studies on older women with breast cancer: a systematic review. BMC Geriatr 2024; 24:563. [PMID: 38937703 PMCID: PMC11212278 DOI: 10.1186/s12877-024-05152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Breast cancer and frailty frequently co-occur in older women, and frailty status has been shown to predict negative health outcomes. However, the extent to which frailty assessments are utilized in observational research for the older breast cancer population is uncertain. Therefore, the aim of this review was to determine the frequency of use of frailty assessments in studies investigating survival or mortality, and characterize them, concentrating on literature from the past 5 years (2017-2022). METHODS MEDLINE, EMBASE and Cochrane Library were systematically queried to identify observational studies (case-control, cohort, cross-sectional) published from 2017-2022 that focus on older females (≥ 65 years) diagnosed with breast cancer, and which evaluate survival or mortality outcomes. Independent reviewers assessed the studies for eligibility using Covidence software. Extracted data included characteristics of each study as well as information on study design, study population, frailty assessments, and related health status assessments. Risk of bias was evaluated using the appropriate JBI tool. Information was cleaned, classified, and tabulated into review level summaries. RESULTS In total, 9823 studies were screened for inclusion. One-hundred and thirty studies were included in the final synthesis. Only 11 (8.5%) of these studies made use of a frailty assessment, of which 4 (3.1%) quantified frailty levels in their study population, at baseline. Characterization of frailty assessments demonstrated that there is a large variation in terms of frailty definitions and resulting patient classification (i.e., fit, pre-frail, frail). In the four studies that quantified frailty, the percentage of individuals classified as pre-frail and frail ranged from 18% to 29% and 0.7% to 21%, respectively. Identified frailty assessments included the Balducci score, the Geriatric 8 tool, the Adapted Searle Deficits Accumulation Frailty index, the Faurot Frailty index, and the Mian Deficits of Accumulation Frailty Index, among others. The Charlson Comorbidity Index was the most used alternative health status assessment, employed in 56.9% of all 130 studies. Surprisingly, 31.5% of all studies did not make use of any health status assessments. CONCLUSION Few observational studies examining mortality or survival outcomes in older women with breast cancer incorporate frailty assessments. Additionally, there is significant variation in definitions of frailty and classification of patients. While comorbidity assessments were more frequently included, the pivotal role of frailty for patient-centered decision-making in clinical practice, especially regarding treatment effectiveness and tolerance, necessitates more deliberate attention. Addressing this oversight more explicitly could enhance our ability to interpret observational research in older cancer patients.
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Affiliation(s)
- Dafne N Sanchez
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zürich, Hirschengraben 82, Zurich, CH-8001, Switzerland
| | - Marloes G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jose A Verstijnen
- Department of Medical Oncology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zürich, Hirschengraben 82, Zurich, CH-8001, Switzerland
| | | | - Frederiek Van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zürich, Hirschengraben 82, Zurich, CH-8001, Switzerland.
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Oey O, Wijaya W, Redfern A. Eribulin in breast cancer: Current insights and therapeutic perspectives. World J Exp Med 2024; 14:92558. [PMID: 38948420 PMCID: PMC11212747 DOI: 10.5493/wjem.v14.i2.92558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 03/20/2024] [Indexed: 06/19/2024] Open
Abstract
Eribulin is a non-taxane synthetic analogue approved in many countries as third-line treatment for the treatment of patients with metastatic breast cancer. In addition to its mitotic property, eribulin has non-mitotic properties including but not limited to, its ability to induce phenotypic reversal of epithelial to mesenchymal transition, vascular remodelling, reduction in immunosuppressive tumour microenvironment. Since approval, there has been a surge in studies investigating the application of eribulin as an earlier-line treatment and also in combination with other agents such as immunotherapy and targeted therapy across all breast cancer sub-types, including hormone receptor positive, HER2 positive and triple negative breast cancer, many demonstrating promising activity. This review will focus on the application of eribulin in the treatment of metastatic breast cancer across all subtypes including its role as an earlier-line agent, its toxicity profile, and potential future directions.
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Affiliation(s)
- Oliver Oey
- Faculty of Medicine, University of Western Australia, Nedlands 6009, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands 6009, WA, Australia
| | - Wynne Wijaya
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, United Kingdom
- Department of Internal Medicine, Universitas Gadjah Mada, Sleman 55281, Indonesia
| | - Andrew Redfern
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch 6150, WA, Australia
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Jackson EB, Curry L, Mariano C, Hsu T, Cook S, Pezo RC, Savard MF, Desautels DN, Leblanc D, Gelmon KA. Key Considerations for the Treatment of Advanced Breast Cancer in Older Adults: An Expert Consensus of the Canadian Treatment Landscape. Curr Oncol 2023; 31:145-167. [PMID: 38248095 PMCID: PMC10814011 DOI: 10.3390/curroncol31010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
The prevalence of breast cancer amongst older adults in Canada is increasing. This patient population faces unique challenges in the management of breast cancer, as older adults often have distinct biological, psychosocial, and treatment-related considerations. This paper presents an expert consensus of the Canadian treatment landscape, focusing on key considerations for optimizing selection of systemic therapy for advanced breast cancer in older adults. This paper aims to provide evidence-based recommendations and practical guidance for healthcare professionals involved in the care of older adults with breast cancer. By recognizing and addressing the specific needs of older adults, healthcare providers can optimize treatment outcomes and improve the overall quality of care for this population.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Lauren Curry
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Caroline Mariano
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Tina Hsu
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Sarah Cook
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
- Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Rossanna C. Pezo
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada;
- Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Marie-France Savard
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada (M.-F.S.)
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Danielle N. Desautels
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
- Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Dominique Leblanc
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC G1V 0A6, Canada
| | - Karen A. Gelmon
- BC Cancer Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada; (L.C.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Laface C, Giuliani F, Melaccio A, Pappagallo MN, Santoro AN, Perrone M, De Santis P, Guarini C, Carrozzo D, Fedele P. The Treatment Landscape of Elderly Patients with Hormone Receptor-Positive Her2 Negative Advanced Breast Cancer: Current Perspectives and Future Directions. J Clin Med 2023; 12:6012. [PMID: 37762952 PMCID: PMC10532156 DOI: 10.3390/jcm12186012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/26/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Breast cancer (BC) in elderly women is an increasing health issue due to demographic changes. BC tends to present later and may receive less than standard treatment options. More often, BC in elderly patients is endocrine-positive (HR+). The treatment of elderly patients with metastatic BC (mBC) represents a therapeutic challenge. In recent years, the treatment landscape of patients that are HR+/Her2-negative has changed due to the introduction in clinical practice of new targeted drugs, which have improved patient outcomes. Elderly patients are a small percentage of all patients enrolled in clinical trials and, to date, there are no standardized guidelines that define the best treatment option for this patient population. This can lead to undertreatment or overtreatment, impacting patient morbidity and mortality. Geriatric Assessment tools to tailor the treatment in elderly patients are underused because they are long and difficult to apply in a busy routine clinical practice. For all these reasons, there is an urgent need to produce data about the best treatment for elderly patients with HR+ mBC. Herein, we report data from randomized clinical trials and real-world evidence on the therapeutic options for HR+ Her2-negative mBC elderly patients and explore future treatment directions.
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Affiliation(s)
- Carmelo Laface
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Francesco Giuliani
- Medical Oncology, San Paolo Hospital, ASL Bari, 70123 Bari, Italy; (F.G.); (A.M.); (M.N.P.)
| | - Assunta Melaccio
- Medical Oncology, San Paolo Hospital, ASL Bari, 70123 Bari, Italy; (F.G.); (A.M.); (M.N.P.)
| | - Maria Nicla Pappagallo
- Medical Oncology, San Paolo Hospital, ASL Bari, 70123 Bari, Italy; (F.G.); (A.M.); (M.N.P.)
| | - Anna Natalizia Santoro
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Martina Perrone
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Pierluigi De Santis
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Chiara Guarini
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Daniela Carrozzo
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
| | - Palma Fedele
- Medical Oncology, Dario Camberlingo Hospital, 72021 Francavilla Fontana, Italy (A.N.S.); (M.P.); (P.D.S.); (C.G.); (D.C.)
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Chedeville C, Reynes H, Nobre K, Benderra MA. [Medical oncology treatment]. SOINS. GERONTOLOGIE 2022; 27:13-17. [PMID: 36280366 DOI: 10.1016/j.sger.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Although patients over 65 years of age represent the majority of breast cancer patients, we have limited data on the safety and efficacy of medical oncology treatments in this population. Their indications are based primarily on expert agreement. This literature review discusses the known data on the safety and efficacy of the main medical treatments for breast cancer: chemotherapy, cytokine-dependent kinase inhibitors 4/6, agents targeting human epidermal growth factor receptor-2, novel antibody conjugates, and immunotherapy.
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Affiliation(s)
- Céline Chedeville
- Département d'oncologie médicale, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Hortense Reynes
- Département d'oncologie médicale, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Katia Nobre
- Département d'oncologie médicale, clinique Hartmann, 26 bd Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - Marc-Antoine Benderra
- Département d'oncologie médicale, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020 Paris, France; Département d'oncologie médicale, clinique Hartmann, 26 bd Victor-Hugo, 92200 Neuilly-sur-Seine, France; IUC, AP-HP Sorbonne Université, 75000 Paris, France.
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Pranav P, Palaniyandi T, Baskar G, Ravi M, Rajendran BK, Sivaji A, Ranganathan M. Gene expressions and their significance in organoid cultures obtained from breast cancer patient-derived biopsies. Acta Histochem 2022; 124:151910. [PMID: 35667159 DOI: 10.1016/j.acthis.2022.151910] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 12/12/2022]
Abstract
Gene expression changes are one of the hallmarks of malignant cells and such changes in specific genes have been identified for a variety of human cancers. Such an association in gene expression changes becomes very significant for breast cancers due to the genetic heterogeneity seen in such cancers. It is due to such genetic implication that breast cancers are classified into several subtypes; based on the expression and the magnitude of expression of estrogen and progesterone receptor genes. Changes in the expression of ERBB2, ESR1, PLAU, MUC1, PGR, and TP53 are implicated in breast cancers. Of the various models available for cancer research, organoid cultures from patient-derived biopsies are being considered as the most relevant for invitro testing. Organoid cultures derived from patient biopsies mitigate several limitations of other commonly available models such as cancer cell lines. Such organoids retain the functional physiology of solid tumors which include gene expression. Also, utilizing patient derived organoids for in vitro testing paves way for personalized medicine which greatly enhances the effectiveness of cancer therapy for individuals. We present the genes implicated in breast cancers, the ways in which organoids can be derived from breast cancer biopsies and their applications for gene expression studies.
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Chan WL, Marinho J, Chavarri-Guerra Y, Hincapie-Echeverri J, Velasco RN, Akagunduz B, Roy M, Kwong WTG, Wu WF, Battisti NML, Soto-Perez-de-Celis E. Systemic treatment for triple negative breast cancer in older patients: A Young International Society of Geriatric Oncology Review Paper. J Geriatr Oncol 2022; 13:563-571. [DOI: 10.1016/j.jgo.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/04/2022] [Indexed: 12/27/2022]
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Updated recommendations regarding the management of older patients with breast cancer: a joint paper from the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG). Lancet Oncol 2021; 22:e327-e340. [PMID: 34000244 DOI: 10.1016/s1470-2045(20)30741-5] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023]
Abstract
Breast cancer is increasingly prevalent in older adults and is a substantial part of routine oncology practice. However, management of breast cancer in this population is challenging because the disease is highly heterogeneous and there is insufficient evidence specific to older adults. Decision making should not be driven by age alone but should involve geriatric assessments plus careful consideration of life expectancy, competing risks of mortality, and patient preferences. A multidisciplinary taskforce, including members of the European Society of Breast Cancer Specialists and International Society of Geriatric Oncology, gathered to expand and update the previous 2012 evidence-based recommendations for the management of breast cancer in older individuals with the endorsement of the European Cancer Organisation. These guidelines were expanded to include chemotherapy toxicity prediction calculators, cultural and social considerations, surveillance imaging, genetic screening, gene expression profiles, neoadjuvant systemic treatment options, bone-modifying drugs, targeted therapies, and supportive care. Recommendations on geriatric assessment, ductal carcinoma in situ, screening, primary endocrine therapy, surgery, radiotherapy, adjuvant systemic therapy, and secondary breast cancer were updated.
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Chabot I, Zhao Q, Su Y. Systematic review of Real-World effectiveness of eribulin for locally advanced or metastatic breast cancer. Curr Med Res Opin 2020; 36:2025-2036. [PMID: 33044090 DOI: 10.1080/03007995.2020.1835853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Eribulin mesylate (eribulin) is indicated for patients with metastatic breast cancer (MBC) who have previously received at least two chemotherapies in the US and for patients with locally advanced breast cancer (LABC) or MBC who have progressed after at least one chemotherapy in the European Union (EU). In both indications, prior therapy should include an anthracycline and a taxane in adjuvant or metastatic setting. Numerous studies evaluated eribulin in real-world (RW) breast cancer populations to reinforce its consistent effectiveness beyond registration randomized controlled trials (RCTs) that reported median overall survival (OS) of 13.1 and 15.9 months. In this systematic literature review (SLR), we summarize the cumulative evidence on eribulin's RW effectiveness in LABC/MBC. METHODS We searched through Medline/PubMed and Embase databases between 2012 and 2019 for articles reporting RW eribulin use in the second- or third-line or later LABC/MBC setting. Because eribulin showed greatest OS benefits in triple negative breast cancer (TNBC) in RCTs, we also reviewed this tumor subtype. OS and progression-free survival (PFS) were the effectiveness outcomes of interest. RESULTS Overall, 34 journal articles or abstracts met the selection criteria. Median OS ranged between 6.9 and 28.0 months; median PFS varied from 2.3 to 14.7 months. Eight studies reported OS outcomes for TNBC patients, and median OS ranged between 3.0 and 23.0 months. CONCLUSION The SLR showed high variability in OS and to a lesser extent in PFS associated with eribulin use in RW setting. Despite heterogeneity in line of use and patient subtypes, this SLR supports effectiveness of eribulin for LABC/MBC in clinical practice.
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Affiliation(s)
- Isabelle Chabot
- Faculty of Pharmacy, Montreal University, Montreal, Quebec, Canada
- Global Value & Access, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Qi Zhao
- Global Value & Access, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Yun Su
- Formerly of Global Value & Access, Eisai Inc., Woodcliff Lake, NJ, USA
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Chemotherapy Options beyond the First Line in HER-Negative Metastatic Breast Cancer. JOURNAL OF ONCOLOGY 2020; 2020:9645294. [PMID: 33312203 PMCID: PMC7719522 DOI: 10.1155/2020/9645294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/05/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
Despite the recent advances in the biological understanding of breast cancer (BC), chemotherapy still represents a key component in the armamentarium for this disease. Different agents are available as mono-chemotherapy options in patients with locally advanced or metastatic BC (MBC) who progress after a first- and second-line treatment with anthracyclines and taxanes. However, no clear indication exists on what the best option is in some populations, such as heavily pretreated, elderly patients, triple-negative BC (TNBC), and those who do not respond to the first-line therapy. In this article, we summarize available literature evidence on different chemotherapy agents used beyond the first-line, in locally advanced or MBC patients, including rechallenge with anthracyclines and taxanes, antimetabolite and antimicrotubule agents, such as vinorelbine, capecitabine, eribulin, ixabepilone, and the newest developed agents, such as vinflunine, irinotecan, and etirinotecan.
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Pedersini R, di Mauro P, Amoroso V, Parati MC, Turla A, Ghilardi M, Vassalli L, Ardine M, Volta AD, Monteverdi S, Borgonovo K, Ghidini A, Cabiddu M, Simoncini EL, Petrelli F, Berruti A, Barni S. Efficacy of Eribulin mesylate in older patients with breast cancer: A pooled analysis of clinical trial and real-world data. J Geriatr Oncol 2020; 11:976-981. [PMID: 32299685 DOI: 10.1016/j.jgo.2020.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/08/2020] [Accepted: 03/30/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Eribulin mesylate (EM) is a non-taxane microtubule inhibitor approved for use in patients with metastatic breast cancer. With this pooled analysis of retrospective studies, we evaluated the efficacy and toxicity profile of EM in older patients with breast cancer in the real-world setting. METHODS We performed a systematic database search for studies published up to March 2019 and reporting outcome and adverse events with EM in older patients (≥70 years). Overall survival (OS), progression-free survival (PFS), and overall response rate (ORR) were described and aggregated in a pooled analysis. Main toxicity rates (G1-2 and G3-4) were also described. RESULTS The analysis included five studies for a total of 301 patients. The median age was 71 to 74 years. Pooled ORR, median PFS and OS were 23.2%, 4.8 and 13.1 months, respectively. The disease control rate was 47%. Grade 3-4 neutropenia was 0 to 49%, G3-4 anemia and thrombocytopenia were rare. The most frequent G3-4 adverse events among non-hematological toxicities were fatigue (5-16.5%) and neurotoxicity (0-10.1%). Dose reduction rate was reported in three studies and carried out in 40% of patients (18.6-84%). CONCLUSIONS This pooled analysis shows that the median OS in older patients with breast cancer is 13 months, with an ORR of 23%. Control of disease was achieved in about 50% of patients. Dose reduction was relatively frequent and severe toxicities were rare. EM treatment of older patients with breast cancer is feasible and reflects the outcomes for the general population.
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Affiliation(s)
- Rebecca Pedersini
- Breast Unit-Oncology Department, Spedali Civili Hospital, Brescia, Italy.
| | | | - Vito Amoroso
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | | | - Antonella Turla
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Mara Ghilardi
- Oncology Department, Treviglio-Caravaggio Hospital, Treviglio, Italy
| | - Lucia Vassalli
- Breast Unit-Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Mara Ardine
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | | | - Sara Monteverdi
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Karen Borgonovo
- Oncology Department, Treviglio-Caravaggio Hospital, Treviglio, Italy
| | | | - Mary Cabiddu
- Oncology Department, Treviglio-Caravaggio Hospital, Treviglio, Italy
| | | | - Fausto Petrelli
- Oncology Department, Treviglio-Caravaggio Hospital, Treviglio, Italy
| | - Alfredo Berruti
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Sandro Barni
- Oncology Department, Treviglio-Caravaggio Hospital, Treviglio, Italy
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Barni S, Livraghi L, Gravina A, Martella F, D'Onofrio L, Morritti M, Michelotti A, Vici P, Mentuccia L, Porcu L, Orditura M, Puglisi F. Feasibility of Eribulin Mesylate in older patients with locally advanced or metastatic breast cancer: A post-hoc analysis of the ESEMPiO study. J Geriatr Oncol 2019; 10:990-993. [PMID: 31097340 DOI: 10.1016/j.jgo.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/29/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Sandro Barni
- Treviglio Hospital, ASST-Bergamo Ovest, Treviglio, Italy.
| | | | - Adriano Gravina
- National Cancer Institute Fondazione G. Pascale, Napoli, Italy
| | | | | | - Maria Morritti
- Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Patrizia Vici
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Fabio Puglisi
- Unit of Medical Oncology and Prevention, IRCCS Centro di Riferimento Oncologico Aviano-National Cancer Institute, Aviano (UD), Italy; Medical Oncology, Department of Medicine, University of Udine, Italy
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O'Shaughnessy J, Kaklamani V, Kalinsky K. Perspectives on the mechanism of action and clinical application of eribulin for metastatic breast cancer. Future Oncol 2019; 15:1641-1653. [DOI: 10.2217/fon-2018-0936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Eribulin is a novel microtubule inhibitor with mitotic and nonmitotic mechanisms of action. Both pooled and subgroup analyses from large-scale Phase III clinical trials demonstrated that eribulin has substantial activity in patients with pretreated (anthracycline and a taxane) advanced or metastatic breast cancer. We review recent pharmacological and clinical findings pertaining to eribulin use in metastatic breast cancer – particularly highlighting eribulin in difficult-to-treat and aggressive disease, and safety data in specific patient populations. Additionally, recent advancements in our understanding of the mechanism of action of eribulin and potential future directions for its clinical development are discussed. Ongoing studies of eribulin in combination with immunotherapies and established cytotoxic agents may help shape the future landscape of breast cancer treatment.
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Affiliation(s)
- Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA
| | - Virginia Kaklamani
- Department of Medicine, Division of Hematology/Oncology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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