Adjuvant Chemotherapy in Older Women With Early Breast Cancer

Abstract

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology , to patients seen in their own clinical practice. The clinical discussion on the adjuvant chemotherapy in older patients with breast cancer (BC) should routinely include comprehensive considerations of the health implications of competitive comorbidities, the safety of the treatment itself, and the likelihood that an appropriate dose intensity will be received (ie, relative dose intensity > 85%). All these factors have prognostic implications, as recently confirmed in the secondary analysis of the Hurria Older PatiEnts clinical trial. Full-informed, shared decision making is essential to provide best care. Our clinical approach for women with BC age ≥ 65 years is based on a standardized screening for frailty, triggering comprehensive geriatric assessment, as appropriate. We only recommend evidence-based regimens that have showed to reduce the risk of cancer recurrence and potentially increase overall survival. We frequently prefer docetaxel-cyclophosphamide, for hormone receptor–positive BC, on the basis of the subgroup analysis of the USOR-9735 study in older population. We avoid single agents (eg, capecitabine or weekly docetaxel), as showed to be inferior treatments in the CALGB-49907 and ELDA trials, and modified nonstandard regimens, for the lack of strong evidence in support.

Nanoparticles for efficient drug delivery and drug resistance in glioma: New perspectives

“…Chemotherapy resistance is a common challenge in tumor therapy because tumor cells acquire resistance to chemotherapeutic drugs and are unable to effectively kill tumor cells 16,17 . This phenomenon is usually caused by biochemical mechanisms within the tumor cells, such as drug efflux, drug catabolism, DNA repair 18–23 . In the field of oncology, NPs have been extensively studied as drug carriers to overcome the problem of drug resistance faced by conventional chemotherapeutic agents 24,25 .…”

“… 16 , 17 This phenomenon is usually caused by biochemical mechanisms within the tumor cells, such as drug efflux, drug catabolism, DNA repair. 18 , 19 , 20 , 21 , 22 , 23 In the field of oncology, NPs have been extensively studied as drug carriers to overcome the problem of drug resistance faced by conventional chemotherapeutic agents. 24 , 25 NPs as drug carriers have the following advantages.…”

Does age affect outcome with breast cancer?

“…While there exist a unique spectrum of patient-important survivorship issues among both younger and elderly breast cancer patients, accurate predictions of outcomes and patterns of relapse provide invaluable information to all patients living with cancer, and can help to inform physicians making treatment recommendations [ 21 ]. In this study, we examine the impact of both young and older age at diagnosis on outcomes in a contemporary breast cancer treatment context.…”