Is cancer biology different in older patients?

Herck, Yannick Van; Feyaerts, Annelies; Alibhai, Shabbir M.H.; Papamichael, Demetris; Decoster, Lore; Lambrechts, Yentl; Pinchuk, M. É.; Bechter, Oliver; Herrera-Cáceres, Jaime O.; Bibeau, Frédéric; Desmedt, Christine; Hatse, Sigrid; Wildiers, Hans

doi:10.1016/s2666-7568(21)00179-3

Cited by 77 publications

(66 citation statements)

References 187 publications

(229 reference statements)

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“…These drugs are currently as efficient, or less efficient, in older than in younger patients depending on the tumor site [ 91 ], but we lack biomarkers predictive of patients’ response to these drugs. More generally, as highlighted in a recent review, differences in cancer biology according to age seem clearer regarding histology and mutational landscape than immunological features [ 92 ].…”

Section: Discussionmentioning

confidence: 99%

Does Inflammation Contribute to Cancer Incidence and Mortality during Aging? A Conceptual Review

Guerville

Bourdel-Marchasson

Déchanet‐Merville

et al. 2022

Cancers

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Aging is associated with chronic low-grade inflammation, cancer incidence and mortality. As inflammation contributes to cancer initiation and progression, one could hypothesize that age-associated chronic low-grade inflammation contributes to the increase in cancer incidence and/or mortality observed during aging. Here, we review the evidence supporting this hypothesis: (1) epidemiological associations between biomarkers of systemic inflammation and cancer incidence and mortality in older people, (2) therapeutic clues suggesting that targeting inflammation could reduce cancer incidence and mortality and (3) experimental evidence from animal models highlighting inflammation as a link between various mechanisms of aging and cancer initiation and progression. Despite a large body of literature linking aging, inflammation and cancer, convincing evidence for the clear implication of specific inflammatory pathways explaining cancer incidence or mortality during aging is still lacking. Further dedicated research is needed to fill these gaps in evidence and pave the way for the development of applications in clinical care.

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Section: Discussionmentioning

confidence: 99%

Does Inflammation Contribute to Cancer Incidence and Mortality during Aging? A Conceptual Review

Guerville

Bourdel-Marchasson

Déchanet‐Merville

et al. 2022

Cancers

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“…With age, the number of cardiovascular risk factors increases, their treatment is less intensive, and cardioprotective properties are diminished, leading to increased cardiotoxicity rates in the elderly [ 16 ]. A more advanced cancer stage may be associated with more intensive and/or complex cancer treatment, which can cause more cardiovascular complications.…”

Section: Discussionmentioning

confidence: 99%

Development of a Cardio-Oncology Service in Lithuania: Prediction, Prevention, Monitoring and Treatment of Cancer Treatment-Induced Cardiotoxicity

Čiburienė

Aidietienė

Ščerbickaitė

et al. 2022

JCDD

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Background: Advances in cancer therapy have dramatically improved outcomes for cancer patients. However, cancer treatment can cause several cardiovascular (CV) complications, increasing cardiac mortality and morbidity in cancer patients and survivors. As a result, a new cardiology subspecialty—cardio-oncology (CO)—has been developed. The goals of CO are to understand the mechanism of the cardiotoxicity (CTX) of cancer therapies and invent the best monitoring and treatment strategies to improve the survival of cancer patients. Methods: We performed a retrospective observational study reporting on the 6-year experience of the first CO service in Vilnius, Lithuania. Cancer patients were consulted by a single part-time specialist at Vilnius University Hospital. All new patients underwent blood tests, including cardiac biomarkers and advanced transthoracic echocardiogram (TTE) with stress protocol if indicated. During a follow-up, we evaluated the association of patient survival with such variables as age, gender, reasons for referral, cancer location and stage, cardiovascular (CV) risk factors (RF), and rates and stage of CTX and treatment strategies. Results: 447 patients were consulted (70% females), and the median age was 64 years. Cardiovascular (CV) RF was common: 38.5% of patients had hypertension, almost 38% had dyslipidemia, 29% were obese, 10% were smokers, and 9% had diabetes. Nearly 26% of patients had a history of HF. Early biochemical cardiotoxicity was determined in 27%, early functional cardiotoxicity was seen in 17%, and early mixed cardiotoxicity—in 45% of referred patients treated with cardiotoxic cancer therapies. In addition, reduced left ventricular ejection fraction (LVEF) was found in 7% of patients. Beta-blockers (BB) were administered to 61.1% of patients, while angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) to 54.1% of patients. In addition, 18.3% of patients received loop diuretics and almost 12% mineralocorticoid receptor antagonists (MRA), respectively. A total of 143 patients died during the 6-year follow-up period. The leading cause of death was primarily cancer (92.3%). Only in 5.6% of patients, cardiovascular complications were reported as the cause of death, and 2.1% of deaths were due to the COVID–19 infection. We found that age (HR 1.020 [95% CI: (1.005–1.036)] p = 0.009); LV diastolic dysfunction (HR 1.731 [95% CI: 1.115–2.689] p = 0.015; NYHA stage II (HR 2.016 [95% CI: 1.242–3.272] p = 0.005; NYHA stage III (HR 3.545 [95% CI: 1.948–6.450] p < 0.001; kidney dysfunction (HR 2.085 [95% CI: 1.377–3.159] p = 0.001; previous cancer (HR 2.004 [95% CI: 1.219–3.295] p = 0.006); tumor progression (HR 1.853 [95% CI: 1.217–2.823] p = 0.004) and lung cancer (HR 2.907 [95%CI: 1.826–4.627] p < 0.001) were statistically significantly associated with the increased risk of all-cause death. Conclusions: CO is a rapidly growing subspecialty of cardiology that aims to remove cardiac disease as a barrier to effective cancer treatment by preventing and reversing cardiac damage caused by cancer therapies. Establishing a CO service requires a cardiologist with an interest in oncology. Continuous education, medical training, and clinical research are crucial to success. Age, previous cancer, tumor progression, kidney dysfunction, left ventricular diastolic dysfunction, and NYHA stages were associated with increased mortality.

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“…Although the proportion of HER2 positive tumors is generally thought to be lower in older patients, still 10–15% present with breast cancers with HER2 overexpression [ [7] , [8] , [9] ]. The prognosis of patients with metastatic HER2+ breast cancer has dramatically improved over the past decade, mainly due to the introduction of more effective HER2-directed therapies [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Long term outcome data from the EORTC 75111-10114 ETF/BCG randomized phase II study: Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer, followed by T-DM1 after progression

et al. 2022

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Is cancer biology different in older patients?

Cited by 77 publications

References 187 publications

Does Inflammation Contribute to Cancer Incidence and Mortality during Aging? A Conceptual Review

Does Inflammation Contribute to Cancer Incidence and Mortality during Aging? A Conceptual Review

Development of a Cardio-Oncology Service in Lithuania: Prediction, Prevention, Monitoring and Treatment of Cancer Treatment-Induced Cardiotoxicity

Long term outcome data from the EORTC 75111-10114 ETF/BCG randomized phase II study: Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer, followed by T-DM1 after progression

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