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Breast cancer: Who does not need chemotherapy?
2013 SIOG Speaker Abstracts
Abstract: In an overview results will be presented focusing on indications for radiotherapy focusing on elderly patients. Results from studies will be discussed with a focus to daily practice. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.207
S9
radiotherapy may prove superior. This is particularly true as the longterm sequelae of radiotherapy, notably second cancers, are not nearly as relevant in the older age group. Newer drugs, particularly the targeted drugs such as antibodies and small molecules have also improved outcome for older patients, and the intensive research in this area is likely to lead to improvements in the treatment of older patients with hematologic malignancies. Disclosure of Interest: None Declared. Keywords: None
S05 Breast cancer: Who does not need chemotherapy?
doi:10.1016/j.jgo.2013.09.209
H. Wildiers⁎. General Medical Oncology, University Hospitals Leuven, Leuven, Belgium Abstract: We should turn around the question of the title. The majority of older breast cancer patients does not benefit from adjuvant chemotherapy. The major challenge is to select those older patients that do benefit from chemotherapy. Four factors can be defined that determine together whether chemotherapy will be beneficial in an individual patient. (i) Tumor extent including tumor size and nodal involvement is a well-established strong prognostic factor in general, and the absolute benefit of chemotherapy increases with higher tumor load. (ii) General health status, as assessed by geriatric evaluation, is strongly associated with expected life expectancy and tolerance of chemotherapy. A geriatric assessment is thus of paramount importance before deciding on adjuvant chemotherapy. Frail patients are likely to tolerate chemotherapy poorly and/or die from other causes in the following years, and generally do not benefit from adjuvant chemotherapy. (iii) Tumor biology as indicated by breast cancer subtype predicts chemosensitivity and benefit from adjuvant chemotherapy. The indication for adjuvant chemotherapy in luminal A, B, triple negative and HER2 positive breast cancer will be discussed separately. (iiii) Last but not least, patients should be involved as much as possible; estimated benefits of e.g. 10% absolute decrease in relapse rate might be valuable for 1 person but not for another person. Studies show that the quality of provider communication influences the choice of patients to receive chemotherapy. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.208
S06 Hematologic malignancies: What are the age-related questions? L. Specht⁎. University of Copenhagen, Copenhagen, Denmark Abstract: Cure rates for many hematologic malignancies, in particular the lymphomas, have improved dramatically over the past 20-30 years. This is particularly true for younger patients. However, due to demographic changes, even lymphomas like Hodgin lymphoma now occur in increasing numbers in older patients. Many of these patients do not tolerate the intensive treatments that have been developed for younger patients. Nevertheless, if older patients are fit enough to tolerate full treatment, their prognosis does not seem to be inferior. But hitherto, efforts of creating “milder” regimens for older patients have failed, as patients have not been cured with these regimens. Hence, the older age group is a major challenge. Clinical trials have focused on young and fit patients, increasing treatment and dose intensity. We now need trials focusing on the older patients, devising treatments that are curative but with less toxicity. In many instances older patients tolerate modern limited radiotherapy well, and treatment regimens including less chemotherapy and more
S07 Opportunities and resources for career development in BTR C. Falandry⁎,1,2. 1Geriatrics, Centre Hospitalier Lyon Sud, Pierre-Benite Cedex; 2Lyon University, Lyon, France Abstract: In 1974, the American Congress granted authority to form National Institute on Aging to provide leadership in aging research, training and health information dissemination. In 2013, Google launches Calico, a health company focused on extending life. In almost 40 years, what could be envision as an academic-centred field has become one of the economic blockbusters, the silver economy. This presentation will aim at encompassing all the current opportunities - academic and non-academic - for career development in Basic-Translational Research, in the different countries. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.210
S08 Barriers to cancer clinical trials: The role of socioeconomic status/Role of SES in Determining Access to Clinical Trials and Treatment S. Papa⁎. Research Oncology, King's College London, London, United Kingdom Abstract: For clinical research to yield data that is applicable in practice it needs to be drawn from the population for which it is intended. Cancer clinical trials have repeatedly been shown to negatively select for minorities, adolescents and the elderly. This problem is well recognised, and strides have been made in improving recruitment to trials globally. Despite this there remains significant inequality. Altering this imbalance requires understanding of why minority groups are not offered the opportunity to enrol, or when they are why they do not take up the option of trial involvement. Recent work has highlighted socioeconomic status as a key barrier to trial access. There is also growing evidence that perceived racial barriers diminish when socioeconomic status is considered. For clinicians referring patients for trials, and counselling patients on trial enrolment an understanding of these barriers will enable improvements at an individual, institutional and national level to access to cancer clinical trials for all patients. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.211
Abstract: In an overview results will be presented focusing on indications for radiotherapy focusing on elderly patients. Results from studies will be discussed with a focus to daily practice. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.207
S9
radiotherapy may prove superior. This is particularly true as the longterm sequelae of radiotherapy, notably second cancers, are not nearly as relevant in the older age group. Newer drugs, particularly the targeted drugs such as antibodies and small molecules have also improved outcome for older patients, and the intensive research in this area is likely to lead to improvements in the treatment of older patients with hematologic malignancies. Disclosure of Interest: None Declared. Keywords: None
S05 Breast cancer: Who does not need chemotherapy?
doi:10.1016/j.jgo.2013.09.209
H. Wildiers⁎. General Medical Oncology, University Hospitals Leuven, Leuven, Belgium Abstract: We should turn around the question of the title. The majority of older breast cancer patients does not benefit from adjuvant chemotherapy. The major challenge is to select those older patients that do benefit from chemotherapy. Four factors can be defined that determine together whether chemotherapy will be beneficial in an individual patient. (i) Tumor extent including tumor size and nodal involvement is a well-established strong prognostic factor in general, and the absolute benefit of chemotherapy increases with higher tumor load. (ii) General health status, as assessed by geriatric evaluation, is strongly associated with expected life expectancy and tolerance of chemotherapy. A geriatric assessment is thus of paramount importance before deciding on adjuvant chemotherapy. Frail patients are likely to tolerate chemotherapy poorly and/or die from other causes in the following years, and generally do not benefit from adjuvant chemotherapy. (iii) Tumor biology as indicated by breast cancer subtype predicts chemosensitivity and benefit from adjuvant chemotherapy. The indication for adjuvant chemotherapy in luminal A, B, triple negative and HER2 positive breast cancer will be discussed separately. (iiii) Last but not least, patients should be involved as much as possible; estimated benefits of e.g. 10% absolute decrease in relapse rate might be valuable for 1 person but not for another person. Studies show that the quality of provider communication influences the choice of patients to receive chemotherapy. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.208
S06 Hematologic malignancies: What are the age-related questions? L. Specht⁎. University of Copenhagen, Copenhagen, Denmark Abstract: Cure rates for many hematologic malignancies, in particular the lymphomas, have improved dramatically over the past 20-30 years. This is particularly true for younger patients. However, due to demographic changes, even lymphomas like Hodgin lymphoma now occur in increasing numbers in older patients. Many of these patients do not tolerate the intensive treatments that have been developed for younger patients. Nevertheless, if older patients are fit enough to tolerate full treatment, their prognosis does not seem to be inferior. But hitherto, efforts of creating “milder” regimens for older patients have failed, as patients have not been cured with these regimens. Hence, the older age group is a major challenge. Clinical trials have focused on young and fit patients, increasing treatment and dose intensity. We now need trials focusing on the older patients, devising treatments that are curative but with less toxicity. In many instances older patients tolerate modern limited radiotherapy well, and treatment regimens including less chemotherapy and more
S07 Opportunities and resources for career development in BTR C. Falandry⁎,1,2. 1Geriatrics, Centre Hospitalier Lyon Sud, Pierre-Benite Cedex; 2Lyon University, Lyon, France Abstract: In 1974, the American Congress granted authority to form National Institute on Aging to provide leadership in aging research, training and health information dissemination. In 2013, Google launches Calico, a health company focused on extending life. In almost 40 years, what could be envision as an academic-centred field has become one of the economic blockbusters, the silver economy. This presentation will aim at encompassing all the current opportunities - academic and non-academic - for career development in Basic-Translational Research, in the different countries. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.210
S08 Barriers to cancer clinical trials: The role of socioeconomic status/Role of SES in Determining Access to Clinical Trials and Treatment S. Papa⁎. Research Oncology, King's College London, London, United Kingdom Abstract: For clinical research to yield data that is applicable in practice it needs to be drawn from the population for which it is intended. Cancer clinical trials have repeatedly been shown to negatively select for minorities, adolescents and the elderly. This problem is well recognised, and strides have been made in improving recruitment to trials globally. Despite this there remains significant inequality. Altering this imbalance requires understanding of why minority groups are not offered the opportunity to enrol, or when they are why they do not take up the option of trial involvement. Recent work has highlighted socioeconomic status as a key barrier to trial access. There is also growing evidence that perceived racial barriers diminish when socioeconomic status is considered. For clinicians referring patients for trials, and counselling patients on trial enrolment an understanding of these barriers will enable improvements at an individual, institutional and national level to access to cancer clinical trials for all patients. Disclosure of Interest: None Declared. Keywords: None doi:10.1016/j.jgo.2013.09.211