Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study

Hancke, Katharina; Denkinger, Michael; König, J.; Kurzeder, Christian; Wöckel, Achim; Herr, D.; Blettner, Maria; Kreienberg, R.

doi:10.1093/annonc/mdp364

Cited by 96 publications

(94 citation statements)

References 24 publications

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“…Several analyses of the registry data have been published so far [16][17][18][19][20], showing, for example, that recurrence-free survival (RFS) and overall survival (OAS) are significantly impacted by guideline-adherent chemotherapy in intermediate and highrisk patients (according to St. Gallen and Nottingham Prognostic Index) and by endocrine therapy in patients with HR (ER)-positive breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Endocrine therapy in obese patients with primary breast cancer: another piece of evidence in an unfinished puzzle

Wolters¹,

Schwentner

Regierer

et al. 2011

Breast Cancer Res Treat

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Obesity, defined as a body mass index (BMI) ≥30 is an independent risk factor in breast cancer and is correlated with shorter survival and enhanced recurrence rates. The present subgroup analysis of the German BRENDA-cohort aimed to investigate the correlation between BMI, recurrence-free survival (RFS) and adjuvant endocrine therapy. In this subgroup analysis, 4,636 patients were retrospectively examined using multivariate analyses. Overall 3,759 (81.1%) patients had a BMI <30 (non-obese) and 877 (18.9%) a BMI ≥30 (obese). In the group of all 3,896 (84.0%) patients with hormone-receptor-positive (HR+) breast carcinomas a significant reduction in RFS was demonstrated for those who were obese (P = 0.002; HR = 1.45 (95% CI: 1.15-1.83)), also after adjustment for Nottingham Prognostic Index (NPI) (P = 0.028; HR = 1.30 (95% CI: 1.03-1.65)). In hormone-receptor-negative (HR-) patients BMI had no influence on RFS (P = 0.380; HR = 1.20 (95% CI: 0.80-1.81)). Considering menopausal status, a significantly shorter RFS was seen in postmenopausal obese than in non-obese patients (P < 0.001; HR = 1.61 (95% CI: 1.24-2.09)), whereas the premenopausal patient group only showed a trend towards a shorter RFS (P = 0.202; HR = 1.44 (95% CI: 0.82-2.53)). The group of HR+ postmenopausal patients with normal or intermediate weight showed a non-significant statistical trend towards a survival benefit for aromatase inhibitors (AI) compared to tamoxifen (RFS: P = 0.486; HR = 1.29 (95% CI: 0.63-2.62), while obese patients tended to benefit more from tamoxifen (RFS: P = 0.289; HR = 0.65 (95% CI: 0.29-1.45)). In accordance with recently published results we demonstrated a negative effect of a high BMI on outcome in primary breast cancer. Furthermore the efficacy of AI seems dependent on BMI in contrast to tamoxifen. Prospective studies to optimise the therapy of obese breast cancer patients are urgently needed.

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Section: Introductionmentioning

confidence: 99%

Endocrine therapy in obese patients with primary breast cancer: another piece of evidence in an unfinished puzzle

Wolters¹,

Schwentner

Regierer

et al. 2011

Breast Cancer Res Treat

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“…The preferred therapeutic management of women with breast cancer aged over 65 corresponds to the concepts formulated for younger patients and complies with the concepts outlined in the S3 Guidelines [8] and the therapy recommendations formulated by AGO [9]. However, as was recently reported by Hancke et al, only some of the elderly patients in Germany receive therapy which complies with the guidelines [10]. Another recent study by Sautter-Bihl et al reviewed the literature on "elderly patients and breast cancer" and came to the conclusion that "female patients with a life expectancy of more than 5 years and not very extensive co-morbidities should receive adjuvant chemotherapy, trastuzumab and radiation in accordance with current standards, while frail elderly women should receive reduced or no adjuvant standard therapy" [11].…”

Section: Zusammenfassungmentioning

confidence: 83%

Chemotherapy for 70-Year-Old Women with Breast Cancer in Germany: A Survey by the German Breast Group

Barinoff

Traut

Bauerschlag

et al. 2013

Geburtsh Frauenheilk

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!Aim: Around half of all women in Germany with breast cancer are older than 65 and approximately one third of them is older than 70 years of age. In theory, the preferred therapeutic management of women with breast cancer aged 65 and above corresponds to that formulated for younger patients and complies with the S3 Guidelines and the therapy recommendations formulated by AGO. To study the current therapies used to treat women with breast cancer aged 70 and above in Germany, a survey of the clinics of the German Breast Group (GBG) was done. Method: An online survey was carried out with requests sent to 599 physicians registered as principal investigators in the database of the GBG. The 12-item questionnaire was used to investigate the systematic therapeutic management of 70-yearold patients in different settings. The indication for chemotherapy was taken as a given. Results: In a neoadjuvant setting, 62 % of physicians opted for anthracycline and taxane-based therapy as did 56.6 % of physicians in an adjuvant setting. One third of physicians preferred a taxane-based therapy with the anti-angiogenesis inhibitor bevacizumab as first-line therapy for primary metastatic cancer and after anthracyclinebased therapy. Capecitabine (around 30%) and navelbine (around 20%) were proposed as second-line neoadjuvant and adjuvant therapies after prior anthracycline-and taxane-based therapy. Conclusion: The chemotherapy regimen prescribed for women with breast cancer aged 70 and above in Germany appears to be relatively standardised and corresponds to the recommendations given in the S3 Guidelines and by the AGO Breast Committee. Zusammenfassung! Ziel: Ca. die Hälfte der Patientinnen mit Mammakarzinom ist über 65 Jahre alt und ca. ein Drittel ist älter als 70 Jahre. Formell entsprechen die therapeutischen Präferenzen für die über 65-jährigen Brustkrebspatientinnen den Konzepten für jün-gere Patientinnen und sind konform mit den Konzepten in der S3-Leitlinie sowie den von der AGO formulierten Therapieempfehlungen. Um das aktuelle Therapieverhalten in Deutschland für über 70-jährige Patientinnen mit Mammakarzinom zu erfassen, wurde eine Umfrage bei Prüfzentren der German Breast Group (GBG) durchgeführt. Methode: Es wurde eine Online-Umfrage unter 599 studienverantwortlichen Ärzten durchgeführt, die in der Datenbank der GBG als Prüf-arzt/ärztin registriert sind. Mit dem 12-Item-Fragebogen wurde die systemische Therapieeinsätze bei einer 70-jährigen Patientin in verschiedenen Settings untersucht. Die Indikation für eine Chemotherapie wurde als gegeben definiert. Ergebnis: 62 % der Ärzte in der Neoadjuvanz und 56,6 % in der Adjuvanz entschieden sich für eine anthrazyklin-und taxanhaltige Therapie. In der primär metastasierenden Situation sowohl in der First-Line-Therapie nach einer anthrazyklinhaltigen Therapie wurde von einem Drittel der Befragten eine taxanhaltige Therapie mit Antiangiogenese-Hemmer Bevacizumab präferiert. Bestand der Status nach anthrazyklin-und taxanhaltiger Therapie in der Neo-/Adjuvanz, so wurden solch...

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“…Many studies also found that there are associations between age and patient-related, physician related and guideline adherent treatments, that influence survival parameter (30)(31)(32). While consensus recommends the use of breast MRI in high risk patients, for staging evaluation to define extent of cancer and identify synchronous lesions (Grade 2B Recommendation by the NCCN)(33) remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Management of Multifocal-Multicentric Breast Cancer: Current Perspective

Milulescu

Marino

Peradze

et al. 2017

chr

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RezumatIncidenţa cancerului de sân multicentric (MC) şi multifocal (MF) are rezultate diverse printre diferitele studii clinice existente în prezent, în principal, din cauza lipsei unei clasificãri şi a unei definiţii standardizatea a acestor douã entitãţi diferite. Tratamentul chirurgical optim pentru cancerul de sân multiplu ipsilateral, rãmâne un subiect de discuţie. Chirurgia conservatoare a sânului are o contraindicaţie relativã în tratamentul cancerului multifocal şi al cancerul multicentric. În acest review narativ am analizat diferenţele dintre cancerul de sân MF şi cel MC, rolul rezonanţei magnetice în detecţia leziunilor multiple ale sânului şi în luarea deciziei tratamentului chirurgical. Am evaluat date din literatura legate de fezabilitatea chirurgiei conservatoare a sânului şi de modalitãţile de tratament loco regional. Studii recente au arãtat cã tratamentul chirurgical conservator al pacientelor cu cancer de sân MF/MC împreunã cu radioterapie şi terapie sistemicã adjuvantã pot avea rate scãzute de recidivã. Pentru a confirma aceste rezultate sunt necesare studii prospective.Cuvinte cheie: sân, cancer, chirurgia conservatoare a sânului, mastectomie, cancer de sân multicentric, cancer de sân multifocal, mastectomie nipplesparing, reconstrucţie mamarã AbstractThe incidence of multifocal (MF) and multicentric (MC) breast cancer has a wide variation among different clinical studies, mostly due to the lack of a standardized classification and definition of these two separate entities. The optimal surgical treatment for multiple ipsilateral breast cancer remains a long debated subject. Multifocal and multicentric breast cancer is usually considered a relative contraindication for breast conserving therapy (BCT). In this narrative review we analyzed differences between MC and MF early breast cancer, the role of magnetic resonance imaging (MRI) in detection of multiple breast lesions, and its role in the surgical approach. We evaluate data from the litera-

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Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study

Abstract: Our study confirms that substandard treatment increases considerably with age. Omission of radiotherapy had the greatest impact on OAS and DFS in the elderly population.

Cited by 96 publications

References 24 publications

Endocrine therapy in obese patients with primary breast cancer: another piece of evidence in an unfinished puzzle

Endocrine therapy in obese patients with primary breast cancer: another piece of evidence in an unfinished puzzle

Chemotherapy for 70-Year-Old Women with Breast Cancer in Germany: A Survey by the German Breast Group

Management of Multifocal-Multicentric Breast Cancer: Current Perspective

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