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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2017; 38(04): 526-534
DOI: 10.4103/ijmpo.ijmpo_96_17
Review Article

A Risk‑benefit Assessment Approach to Selection of Adjuvant Chemotherapy in Elderly Patients with Early Breast Cancer: A Mini Review

Vivek Agarwala
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Neha Choudhary
Department of Surgical Oncology, Breast Surgery Unit, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Sudeep Gupta
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Decision-making regarding the use and selection of adjuvant chemotherapy for breast cancer in elderly patients is challenging due to the presence of age-relatedcomorbidities, frailty, andcompeting causes of mortality. One area, relatively neglected in most guidelines, is the effect ofcompeting causes of mortality on presumed benefit of adjuvant chemotherapy for breast cancer in these patients. This article utilizes a clinical case to illustrate the principles of risk-benefit assessment of adjuvant chemotherapy in elderly patients. We suggest an approach that incorporates validated tools for estimating survival benefits of adjuvant chemotherapy, geriatric assessment, predicting toxicity, and estimating remaining life expectancy without cancer. Integration of all these variables provides a better picture of the possible benefits and harms of adjuvant chemotherapy in this populationcompared to conventional approaches that incorporate tumor-related variables and nonstandard measures of geriatric assessment.

Keywords

Adjuvant chemotherapy - comorbidities - competing causes of mortality - early breast cancer - elderly


Publication History

Article published online:
04 July 2021

© 2017. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used forcommercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Peto R, Davies C, Godwin J, Gray R, Pan HC, et al. Comparisons between different polychemotherapy regimens for early breast cancer: Meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 2012;379:432-44.
  • 2 Muss HB, Woolf S, Berry D, Cirrincione C, Weiss RB, Budman D, et al. Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA 2005;293:1073-81.
  • 3 Muss HB, Berry DA, Cirrincione CT, Theodoulou M, Mauer AM, Kornblith AB, et al. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med 2009;360:2055-65.
  • 4 Jones S, Holmes FA, O'Shaughnessy J, Blum JL, Vukelja SJ, McIntyre KJ, et al. Docetaxel with cyclophosphamide is associated with an overall survival benefitcompared with doxorubicin and cyclophosphamide: 7-year follow-up of US oncology research trial 9735. J Clin Oncol 2009;27:1177-83.
  • 5 Blum JL, Flynn PJ, Yothers G, Asmar L, Geyer CE, Jacobs SA, et al. Anthracyclines in Early Breast Cancer: The ABC Trials-USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 (NRG Oncology). J Clin Oncol 2017;35:2647-55.
  • 6 Adjuvant! Online. Available from: http://www.adjuvantonline.com. [Last accessed on 2017 Mar 01].
  • 7 Predict. Available from: http://www.predict.nhs.uk. [Last accessed on 2017 Mar 01].
  • 8 Henry NL, Somerfield MR, Abramson VG, Allison KH, Anders CK, Chingos DT, et al. Role of patient and disease factors in adjuvant systemic therapy decision making for early-stage, operable breast cancer: American Society of Clinical Oncology Endorsement of Cancer Care Ontario Guideline Recommendations. J Clin Oncol 2016;34:2303-11.
  • 9 Azim HA Jr., de Azambuja E, Colozza M, Bines J, Piccart MJ. Long-term toxic effects of adjuvant chemotherapy in breast cancer. Ann Oncol 2011;22:1939-47.
  • 10 Pinder MC, Duan Z, Goodwin JS, Hortobagyi GN, Giordano SH. Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. J Clin Oncol 2007;25:3808-15.
  • 11 Muss HB, Berry DA, Cirrincione C, Budman DR, Henderson IC, Citron ML, et al. Toxicity of older and younger patients treated with adjuvant chemotherapy for node-positive breast cancer: The Cancer and Leukemia Group B Experience. J Clin Oncol 2007;25:3699-704.
  • 12 Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. J Clin Oncol 2016;34:611-35.
  • 13 Barcenas CH, Niu J, Zhang N, Zhang Y, Buchholz TA, Elting LS, et al. Risk of hospitalization according to chemotherapy regimen in early-stage breast cancer. J Clin Oncol 2014;32:2010-7.
  • 14 Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, et al. Use ofcomprehensive geriatric assessment in older cancer patients: Recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 2005;55:241-52.
  • 15 Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: An update on SIOG recommendations†. Ann Oncol 2015;26:288-300.
  • 16 Puts MT, Santos B, Hardt J, Monette J, Girre V, Atenafu EG, et al. An update on a systematic review of the use of geriatric assessment for older adults in oncology. Ann Oncol 2014;25:307-15.
  • 17 Kanesvaran R, Li H, Koo KN, Poon D. Analysis of prognostic factors ofcomprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol 2011;29:3620-7.
  • 18 Bellera CA, Rainfray M, Mathoulin-Pélissier S, Mertens C, Delva F, Fonck M, et al. Screening older cancer patients:First evaluation of the G-8 geriatric screening tool. Ann Oncol 2012;23:2166-72.
  • 19 Kenis C, Geeraerts A, Braes T, Milisen K, Flamaing J, Wildiers H. The Flemish version of the Triage Risk Screening Tool (TRST): A multidimensional short screening tool for the assessment of elderly patients. Crit Rev Oncol Hematol 2006;60:S31.
  • 20 Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: A prospective multicenter study. J Clin Oncol 2011;29:3457-65.
  • 21 Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 2012;118:3377-86.
  • 22 Schairer C, Mink PJ, Carroll L, Devesa SS. Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 2004;96:1311-21.
  • 23 Global Health Observatory Data Repository: Life Tables by Country. Available from: http://www.who.int. [Last accessed on 2017 Mar 01].
  • 24 Life Expectancy by Age. Available from: http://www.worldlifeexpectancy.com/your-life-expectancy-by-age. [Last accessed on 2017 Mar 01].
  • 25 ePrognosis Calculators. Available from: http://www.eprognosis.com. [Last accessed on 2017 Mar 01].
  • 26 Suemoto CK, Ueda P, Beltrán-Sánchez H, Lebrão ML, Duarte YA, Wong R, et al. Development and validation of a 10-year mortality prediction model: Meta-analysis of individual participant data from five cohorts of older adults in developed and developing countries. J Gerontol A Biol Sci Med Sci 2017;72:410-6.
  • 27 Cruz M, Covinsky K, Widera EW, Stijacic-Cenzer I, Lee SJ. Predicting 10-year mortality for older adults. JAMA 2013;309:874-6.
  • 28 Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. External validation of an index to predict up to 9-year mortality ofcommunity-dwelling adults aged 65 and older. J Am Geriatr Soc 2011;59:1444-51.
  • 29 Satariano WA, Ragland DR. The effect ofcomorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994;120:104-10.
  • 30 Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 1998;16:1582-7.
  • 31 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognosticcomorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373-83.
  • 32 Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, et al. Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale. Psychiatry Res 1992;41:237-48.
  • 33 Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Køber L, Squire IB, et al. Predicting survival in heart failure: A risk score based on 39 372 patients from 30 studies. Eur Heart J 2013;34:1404-13.
  • 34 Heart Failure Risk Calculator. Available from: http://www.heartfailurerisk.org. [Last accessed on 2017 Mar 01].
  • 35 Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, et al. The Seattle Heart Failure Model: Prediction of survival in heart failure. Circulation 2006;113:1424-33.
  • 36 Carmona R, Zakeri K, Green G, Hwang L, Gulaya S, Xu B, et al. Improved method to stratify elderly patients with cancer at risk forcompeting events. J Clin Oncol 2016;34:1270-7.
  • 37 Abdel-Qadir H, Austin PC, Lee DS, Amir E, Tu JV, Thavendiranathan P, et al. Apopulation-based study of cardiovascular mortality following early-stage breast cancer. JAMA Cardiol 2017;2:88-93.