Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations.

Abstract

To evaluate the efficacy and toxicity of electrochemotherapy (ECT) in elderly metastatic breast cancer (BC) patients. Retrospective analysis of 55 patients with superficial metastases who underwent ECT according to the European Standard Operative Procedures of electrochemotherapy. Treatment schedule consisted of intravenous or intratumoral bleomycin followed by locally delivered electric pulses. Statistical comparisons were performed between two groups: the patients aged <70years (n=27) and those ≥70years (n=28). Treatment outcomes were as follows: complete response (CR) rate, local progression-free survival (LPFS), new lesions-free survival (NLFS), toxicity and patient compliance. Patient groups were comparable for clinical-pathological features, except for the number of comorbidities (P<.001). The median follow-up was 32months (range 6-53). Overall, CR rate was 40% and was significantly higher in elderly patients (57 vs. 26%, P=.023) and in patients with better performance status (PS=0-1, 53 vs. PS=2, 21%, P=.048), although local tumor control showed a trend for lower values (2-year LPFS, 67 vs. 93% among elderly and young patients, respectively; P=.061). Older women seemed less likely to progress outside the ECT field (2-year NLFS, 39 vs. 30%, P=.075), but discontinued treatment more frequently due to impaired performance status (P=.002). Local pain was graded ≥3, according to a 10-point visual analog scale, by 16/28 (57.1%) and 8/28 (28.6%) elderly patients at 4 and 8weeks, respectively. Wound debridement was required in 5/28 (18%) older women, due to G3 skin ulceration. Elderly BC patients are highly responsive to ECT and achieve durable local tumor control. Physicians should be aware of possible debilitating side effects, such as pain and skin toxicity. Performance status and frailty screening could be a helpful addition to improve patient selection.