Mina Sedrak, Director of Cancer and Aging Program and Associate Professor of Medicine at UCLA, shared on LinkedIn:
“20 randomized ADC trials. More than 13,000 participants. Not one told us whether ADCs are as safe and tolerable for older adults (≥65y) with breast cancer.
Just published in JNCI. In our systematic review and meta-analysis, we pooled trials of 4 ADCs (T-DXd, SG, T-DM1, Dato-DXd). Although breast cancer is a disease of aging and the median age at diagnosis is 62, only 18% of trial participants were ≥65y.
In metastatic disease, ADCs improved progression-free survival similarly in older and younger participants (pooled HR 0.64 vs 0.58), with no significant age-by-treatment interaction. In early-stage disease, only two trials reported age-stratified outcomes, too few to pool.
Safety was the bigger gap. Only 3 of 20 trials reported grade 3 or higher adverse events by age, only 2 reported treatment discontinuation by age, and none reported dose reductions by age. No trial reported any of these by both age and treatment arm.
Reporting toxicity by age and treatment arm is a simple step. Without these data, we can’t make informed treatment decisions for many of the patients we see in clinic. So what will it take for us to actually change this?
I am so proud of Sam Margolis, a third-year medical student at David Geffen School of Medicine at UCLA who led this incredible work with real rigor and perseverance. Thank you to Tahmineh Romero-Kalbasi, Yuliya Zektser, Arman Niknafs, Joyce Cui, Marla Lipsyc-Sharf, Alexis LeVee, Hope Rugo, Aditya Bardia, and our team at UCLA Health Jonsson Comprehensive Cancer Center.
Thanks to The Breast Cancer Research Foundation, the American Cancer Society, and The National Institutes of Health [including the National Cancer Institute (NCI), the National Institute on Aging (NIA), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)] for your consistent support of our work in Geriatric Oncology.”
Title: Efficacy and toxicity of antibody-drug conjugates in older adults with breast cancer: a systematic review and meta-analysis
Authors: Samuel Margolis, Tahmineh R Kalbasi, Yuliya Zektser, Arman Niknafs, Joyce Cui, Marla D Lipsyc-Sharf, Alexis A LeVee, Hope S Rugo, Aditya Bardia, Mina S Sedrak
Lissandra Dal Lago, Medical Oncologist at CHIREC Hospital Group, commented:
“A must read for clinicians who treat older adults with breast cancer.”
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