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A recent study led by Dr. Mina S. Sedrak at City of Hope Comprehensive Cancer Center in Duarte, California, analyzed clinical and biological factors associated with physical resilience in senior women receiving chemotherapy for early breast cancer. Sedrak’s work recognizes that an older woman’s ability to maintain her daily level of activity is an important endpoint for senior women. This study breaks a pervasive mold in breast cancer clinical trials, providing older participants with relevant endpoints.

The study participants included 406 women who were 65 or older, with a median age of 70 (range 65 – 86). They were recruited from 16 different clinical study sites and received neoadjuvant or adjuvant chemotherapy for stage I – III breast cancer. Physical resilience was assessed before and after chemotherapy, using the deficit accumulation index (DAI). Baseline blood biomarkers of inflammation (IL-6, CRP) and coagulation (D-dimer) were also obtained. Statistical analysis was adjusted for demographic, pretreatment and disease variables.

The study ultimately found that at the end of one month or less of chemotherapy, 78% of participants remained resilient, 19% became prefrail and 3% became frail. Moreover, upon final analysis, participants who had one or more elevated biomarkers at baseline were significantly less likely to be resilient following chemotherapy (OR: 0.15; 95% CI: 0.04 – 0.49; p = 0.002).

The study concludes that resilience to chemotherapy in senior women is associated with inflammatory and coagulation biomarkers. A call to action is made advocating for further research on the role inflammation and coagulation play in the resilience of older women with breast cancer to chemotherapy. With more research, targeted interventions to preserve resilience could be developed. This study is promising in its inclusion of senior women in breast cancer clinical trials and its study of endpoints relevant to this underserved population [1].

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[1] Inflammation and coagulation biomarkers associated with physical resilience in older women receiving chemotherapy for early breast cancer. 2020. https://www.sabcs.org

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