Arti Hurria, MD
Director, Cancer and Aging Research Program
2012-2013 BCRF Project:
Associate Professor of Medical Oncology
Member, Cancer Control and Population Sciences Program
City of Hope Comprehensive Cancer Center
The National Institute of Aging and the National Cancer Institute conducted a joint conference to address key priorities in cancer and aging research. One of the identified areas is need for development of a predictive model (consisting of clinical and biological predictors) that improves the oncologist's ability to anticipate chemotherapy toxicity in older adults with breast cancer.
This subject is important because the greatest risk factor for breast cancer is increasing age. Furthermore, the number of older adults with breast cancer is predicted to increase significantly with the aging of the US population. The vast majority of patients with breast cancer are diagnosed with localized and potentially curable disease. Adjuvant chemotherapy decreases the risk of relapse and mortality from breast cancer; however, the potential benefits need to be weighed against the potential risks for the individual patient. There are limited data to guide these discussions in women age 70 and older. Furthermore, older adults are at increased risk for adjuvant chemotherapy toxicity; however, the specific risk factors for severe or dose-limiting toxicities are not well delineated.
The objective of Dr. Hurria's BCRF-funded research, co-funded with an R01 grant (#AG037037-01A1) is to provide healthcare providers with a predictive model of clinical and biological factors that will allow them to accurately quantify the risk of adjuvant chemotherapy toxicity for a given geriatric patient with breast cancer, as no such tool exists today. BCRF support enables the expansion of the primary aims through the addition of an age-matched control. Dr. Hurria's team aims to develop a predictive model for grade 3-5 chemotherapy toxicity among older adults with breast cancer, which will include geriatric assessment variables and biological markers of aging. They will also assess whether chemotherapy is associated with not only a decline in physical function but also a magnified decline among women who experience grade 3-4 chemotherapy toxicity. They plan to work with women age 65 and older with stage I-III breast cancer and an age-matched control group in these studies.
Mid-year Progress: More than 60% of cancer patients are 65 years and older and approximately 70% of cancer mortality occurs in this population, making cancer a disease of aging. Women 65 and older make up almost half of all new breast cancer diagnoses in the United States. However, even with the association between cancer and aging, there is limited data available to physicians based on clinical trials to guide treatment recommendations, make dose adjustments, and manage treatment-related side effects for older women with breast cancer. Studies have demonstrated that older adults with breast cancer are at increased risk for chemotherapy toxicity; however, no standard method currently exists to identify individuals who are particularly vulnerable. The goal of this study is to fill this gap in knowledge by developing a tool which can help identify individuals at risk for severe side effects from chemotherapy. Dr. Hurria's team is accomplishing this goal through by continuing to enroll a total of 500 adults at cancer centers across the US. They will compare the functioning of these individuals with that of 100 women age 65 and older who have no history of cancer and therefore have not undergone chemotherapy, as well as the functioning of 100 women age 65 and older with breast cancer who will not be receiving chemotherapy. Currently, 11 institutions across the nation are participating in this study. Ultimately, these data will serve as the basis for future intervention studies aimed at decreasing the risk of chemotherapy toxicity and maintaining the function and health of older adults with breast cancer.