title: Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of electrochemotherapy (ECT) in elderly metastatic breast cancer (BC) patients.
  
  
  METHODS
  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 <70 years (n = 27) and those ≥70 years (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.
  
  
  RESULTS
  Patient groups were comparable for clinical-pathological features, except for the number of comorbidities (P < .001). The median follow-up was 32 months (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 8 weeks, respectively. Wound debridement was required in 5/28 (18 %) older women, due to G3 skin ulceration.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata, 64, 35128, Padua, Italy, maximizing@hotmail.com.
authors.forename: Luca G
authors.initials: LG
authors.lastname: Campana
authors.forename: Sara
authors.initials: S
authors.lastname: Galuppo
authors.forename: Sara
authors.initials: S
authors.lastname: Valpione
authors.forename: Antonella
authors.initials: A
authors.lastname: Brunello
authors.forename: Cristina
authors.initials: C
authors.lastname: Ghiotto
authors.forename: Alessia
authors.initials: A
authors.lastname: Ongaro
authors.forename: Carlo R
authors.initials: CR
authors.lastname: Rossi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001761:Bleomycin / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D053672:Electrochemotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001761:Bleomycin