Background: Metastatic breast cancer (MBC) is highly prevalent in middle-aged or elderly patients. Eribulin is a nontaxane microtubule inhibitor, approved for the treatment of pretreated MBC. This multicentric study (sponsored by GIOGer, Italian Group for Geriatric Oncology) was designed to assess the efficacy and tolerability of eribulin, according to parameters usually used in geriatric oncology.
Subjects, materials, and methods: An observational study was conducted on 50 consecutive elderly patients with MBC. The primary endpoint was to evaluate the change in items score of comprehensive geriatric assessment (CGA) and health-related quality of life (HRQL). Italian versions of the CGA and HRQL questionnaires were administered at baseline, before the third and fifth cycles, and then every three cycles until treatment discontinuation. Secondary endpoints were efficacy and safety.
Results: Overall, both EQ-5D scores and EQ-5D-3 L visual analogic scale did not significantly change from baseline; the percentage of subjects without problems doing usual activities tended to decrease during treatment (p for linear trend .018), and the percentage of patients with minor problems performing usual activities tended to increase (p for linear trend.012). Among CGA items, Instrumental Activities of Daily Living tended to decrease during treatment and Geriatric Depression Scale tended to increase. After 12 months follow-up, 24 patients (out of 47) showed clinical benefits; median progression-free survival was 4.49 months (2.10-10.33) and median OS was 7.31 months (3.70-14.03). The treatment was associated with mild toxicity.
Conclusion: Eribulin treatment preserved quality of life and geriatric parameters included in the CGA, except for instrumental functioning and geriatric depression, in elderly patients with MBC.
Implications for practice: A collaboration between oncologist and geriatric specialists is essential in the management of patients with metastatic breast cancer, who are frequently elderly or frail. The assessment of geriatric parameters in the decision-making process can contribute to direct toward the most appropriate therapeutic plan and preserve the quality of life of patients. Eribulin does not seem to affect quality of life or worsen the overall geriatric status; therefore, it can be considered a suitable option for elderly patients with metastatic breast cancer.
摘要
背景。转移性乳腺癌 (MBC) 在中年或老年患者中非常普遍。艾瑞布林是一种非紫杉烷类微管抑制剂，被批准用于经治的转移性乳腺癌。这项多中心研究(由 GIOGer 意大利老年肿瘤研究小组主办)旨在根据老年肿瘤学中常用的参数，评估艾瑞布林的疗效和耐受性。
受试者、材料和方法。对 50 名连续老年转移性乳腺癌患者进行了观察性研究。主要终点是评估综合老年评估 (CGA) 和健康相关生活质量 (HRQL) 项目得分的变化。意大利语版本的 CGA 和 HRQL 问卷在基线、第三和第五周期之前进行，然后每三个周期进行一次，直至治疗停止。次要终点是有效性和安全性。
结果。总体而言，EQ‐5D 评分和 EQ‐5D‐3 L 视觉模拟评分均未从基线发生显著变化；治疗期间，无日常活动问题的受试者百分比倾向于减少(线性趋势 p 值为 0.018)，有轻微日常活动问题的患者百分比趋于增加( 线性趋势 p 值为 0.012)。在 CGA 项目中，工具性日常生活活动在治疗期间趋于减少，并且老年抑郁量表趋于增加。随访 12 个月后，24 名患者(总共 47 名患者)显示出临床受益；中位无进展生存期为 4.49 个月(2.10‐10.33)，中位 OS 为 7.31 个月(3.70‐14.03)。该治疗与轻度毒性有关。
结论。在老年转移性乳腺癌患者中，艾瑞布林治疗保持了生活质量和CGA 中包括的老年参数，除了工具性功能和老年抑郁。
对实践的启示:肿瘤学家和老年专家之间的合作对于转移性乳腺癌患者的管理至关重要，这些患者通常是老年人或体弱者。在决策过程中，老年参数评估有助于直接制定最合适的治疗计划，并保持患者的生活质量。艾瑞布林似乎不会影响生活质量或恶化老年人整体状况；因此，对于患有转移性乳腺癌的老年患者，它可以被认为是合适的选择。
Keywords: Comprehensive geriatric assessment; Elderly; Eribulin mesylate; Health‐related quality of life; Metastatic breast cancer.
© AlphaMed Press 2018.