ABSTRACT
Anoop TMObjectives The lack of data on management of elderly breast cancer patients' population makes most oncologists reluctant to treat them with the standard treatment protocols as advised for the younger patients. This study was done to identify the survival outcome and predictors of survival in elderly breast cancer patients treated with curative intent. Materials and Methods Newly diagnosed patients with breast cancer aged more than 65 years who received treatment with curative intent were included. Disease-free survival (DFS) and overall survival were estimated using the Kaplan-Meier method. Survival curves were compared using log-rank test. Cox regression analysis was done to find out the predictors of DFS. Results This study included 112 elderly breast cancer patients. In our patient population, 79 (70.5%) were less than or equal to 70 years of age and 33 (29.5%) were more than or equal to 70 years. Median age was 68 years. Charlson comorbidity index score was six and above in 31 (28.1) patients. Median DFS in our study was 46 months. Median DFS was not reached in patients less than or equal to 70 years of age, whereas it was 50 months (47-53) among patients more than or equal to 70 years of age, p -value-0.009. In univariate analysis, age more than or equal to 70 years and locally advanced breast cancer were the predictors of DFS with hazard ratio (HR) of 2.8 (1.2-6.69), p -value 0.013 and 2.9 (1.12-7.6), and 0.027, respectively. In multivariate analysis, age more than or equal to 70 years was the only significant predictors of DFS with HR of 2.8 (1.2-6.5) and p -value of 0.015. Conclusion Standard curative intent treatment was well tolerable among elderly patents. Elderly age more than 70 years was a unique predictor of DFS. We need to incorporate tools to assess life expectancy and functional status that will help us predict toxicity of treatment and survival advantage more precisely.
ABSTRACT
BACKGROUND: Carcinoembryonic antigen (CEA) is an important serum tumour marker with a substantial role in diagnosis and monitoring of various solid tumours. About 36%-70% of breast cancers have elevated serum CEA. And the available studies show discrepancy in addressing the prognostic significance of CEA in advanced breast cancer. AIM: To estimate the serum CEA level in our metastatic breast cancer patients and correlate it with response to treatment and clinical outcome. METHODS: This was a prospective clinical study conducted on 50 metastatic breast cancer patients treated at breast clinic, with newly diagnosed metastatic breast cancer planned for palliative chemotherapy, targeted therapy, and hormonal treatment. We estimated the proportion of patients with elevated serum CEA level at baseline and after palliative treatment and also studied the association of serum CEA levels with known prognostic factors. The response to treatment was correlated with the serum CEA levels in the context of responders and non-responders. RESULTS: The median pre-treatment and post-treatment CEA levels were 7.9 (1.8-40.7) ng/mL and 4.39 (1.4-12.15) ng/mL, respectively, in the whole study population (P = 0.032). No statistically significant difference was seen in baseline serum CEA between responders and non-responders. Even in the luminal group, pre-treatment serum CEA was not a predictor of response, but post-treatment CEA was a significant predictor of tumour progression. In patients with liver and lung metastases, post-treatment CEA level difference was not statistically significant in both responders and non-responders though the values were higher in non-responders. Among those with bone metastases, 69.5% had elevated post-treatment serum CEA, and only 37.5% had elevated serum CEA in those with no bone metastases. CONCLUSION: Elevated post-treatment serum CEA levels are associated with disease progression and poor response to therapy. Persistently elevated post-treatment serum CEA levels are significantly associated with bone metastases. Elevated serum CEA and hormonal status are significant predictors of treatment response.
ABSTRACT
FinHer regimen is considered a relatively cardiac safe regimen for Her 2 positive breast cancer in resource-limited settings. There is limited data on cardiotoxicity of this regimen. Out of 1200 patients diagnosed with carcinoma breast during the study period, three hundred Her2-positive early-breast cancer patients received FinHer protocol were included. Among the 300 patients, a total of 71 patients (24%) experienced cardiac toxicity including asymptomatic EF loss in 62 patients (21%) and symptomatic LVEF loss in nine patients (3%). Among patients with symptomatic LVEF loss, six patients had symptomatic cardiac toxicity, one patient (0.3%) had symptoms with fall in EF after completion of treatment, one patient (0.3%) had Congestive cardiac failure (CHF); one patient (0.3%) had non-ST elevation myocardial infarction (NSTEMI). Later, trastuzumab was rechallenged in all 62 patients (24%) with asymptomatic LVEF loss and six patients (2%) with symptomatic LVEF loss. One patient with CHF and NSTEMI was not rechallenged. Hypertension and diabetic mellitus which were the two factors found to have risk on univariate logistic regression analysis although it was not statistically significant. None of these patients further experienced cardiac toxicity at 24 months follow-up except one patient. Although FinHer protocol is considered a cardiac safe protocol, cardiotoxicity associated with trastuzumab which can manifest as an asymptomatic decline in LVEF is more than usually expected in a real-world scenario.
Subject(s)
Breast Neoplasms , Cardiotoxicity , Breast Neoplasms/drug therapy , Cardiotoxicity/etiology , Female , Heart , Humans , Receptor, ErbB-2 , Trastuzumab/adverse effectsABSTRACT
BACKGROUND: Systemic chemotherapy and targeted agents are associated with various cutaneous toxicities. Even though cutaneous toxicities are manageable, it often results in treatment discontinuation and worsens the patients' quality of life. AIM: The study aimed to determine the spectrum of cutaneous toxicities in patients receiving systemic chemotherapy and targeted agents for breast cancer patients. PATIENTS AND METHODS: A total of 250 out of 720 patients with breast cancer who developed various cutaneous toxicities to chemotherapeutic or targeted agents were included in the study. RESULTS: Among 250 patients, 57 patients were on neoadjuvant chemotherapy, 89 patients were on adjuvant chemotherapy, 68 were on palliative chemotherapy for metastatic breast cancer and 36 were on targeted treatment for metastatic breast cancer. The most frequently affected site was hair (96%), followed by skin (92%), nail (34%), and mucosa (26%). The most common dermatological toxicity noticed in our study involved the hair in the form of chemotherapy induced alopecia (anagen effluvium) in 93.6%, followed by skin toxicity with generalized xerosis in 92% and, nail toxicity in 34%, and mucosal toxicity in 26%. The most common chemotherapeutic agent which caused frequent cutaneous toxicities in our patients was docetaxel followed by paclitaxel, capecitabine, doxorubicin, epirubicine, cyclophosphamide, 5-flurouracil and targeted agents like lapatinib, everolimus, and tamoxifen. CONCLUSION: Cutaneous toxicities are common following systemic chemotherapy and targeted agents. Early recognition of cutaneous side effects of these agents and prompt early interventions can reduce the significant morbidity, cosmetic disfigurement, unnecessary treatment interruptions, and psychological distress in women treated for breast cancers.
