Ryan Scott

Personalized treatment for older adults with breast cancer should consider functional status, comorbidities and support systems — not just chronological age.

When treating older patients with breast cancer, it is important to understand that there are many unique aspects that should inform personalized treatment decision-making for this population, according to Dr. Hyman B. Muss, who went on to say that chronological age as it stands by itself is not an adequate measure of health status for these individuals.

Factors to consider when treating these patients can include functional capacity, social support, comorbidities and molecular biomarkers, among others. It is these individualized considerations that make up the patient on a more individual level which will best inform their care.

To further discuss this topic, Muss sat down for an interview with CURE where he discussed treatment considerations, as well as how to understand the life expectancy of older adults with breast cancer, among other important topics.

Muss serves as the Mary Jones Hudson Distinguished Professor of Geriatric Oncology and the director of the Geriatric Oncology Program the University of North Carolina (UNC), UNC-Chapel Hill Lineberger Comprehensive Cancer Center.

CURE: What are some treatment considerations required when treating breast cancer in older patients? How did treatment plans differ from those of younger patients?

: The challenge with older adults is that using age alone doesn't account for the great variability in their health status. If your clinic has 40-year-old women, they will generally be very healthy, and you might intuitively think, "Oh, this is a healthy group." However, in the United States, when someone is 75, there's an intrinsic age bias, a perception that older people are not as fit or able to tolerate things well. Yet, there's great variability.

There are older women, I'm sure you've met, who can play tennis three days a week and move quicker than you or I. Then there are people who are very disabled, and a large middle ground where, when you see them in the clinic, you're just not sure. So, the challenge with older women is not to rely on their chronological age but to actually have an idea of their life expectancy.

How do you approach understanding the life expectancy of older adults with cancer, and what factors beyond the diagnosis do you consider when planning treatment?

Fortunately, there are some wonderful tools for doctors and health professionals, built on the vast datasets the United States has collected on our population over the years, that allow us to accurately predict life expectancy. So, when ‘Mary Smith’ comes in, and you do a geriatric assessment, you find out not just her diagnosis and treatment, but also how functional she is.

Can she take care of herself? Can she do all the activities needed to live independently, use the phone, etc.? Does she have good social support, which, by the way, is related to life expectancy? People who are lonely and don't have many friends, irrespective of their diseases, do worse than a matched person with a similar health status who has friends and is very active. You also look at their medications and other illnesses. You need to put all that information together, which you can, to derive an accurate life expectancy…

That will shape how you talk to the patient, what options you discuss, and what values you want to elicit from the patient concerning their treatments. The challenge is putting all that together in a medical environment that demands high throughput and doesn't frequently allow doctors, nurses, and navigators to do that.

How does aging at the molecular level influence a patient's response to something like chemotherapy?

When we say molecular aging, what does that mean? It refers to the changes we can measure at a cellular level that correlate with the aging process, even if individuals are the same chronological age. For example, you can measure what we call senescent cells in their bodies. As we age, all our organs decline in function. We can't take in as much oxygen through our lungs, our neurons don't fire as quickly, we lose cells and strength in our heart, and our muscles decline.

Why does this happen? As we get older, there are changes in our DNA and proteins. Many cells in our body, in all organs — from the brain and blood to your muscles — become less active. These cells are unable to divide and make new cells, but they don't die. Instead, they can secrete a lot of chemicals, inflammatory factors, and these chemicals can accelerate all types of diseases of aging, including cancer and atherosclerosis. So, when we talk about biologic aging, we measure things like the [number] of senescent cells in your blood or body, the proteins in your blood, and your metabolites. We can then determine that a 50-year-old might biologically be 40 or 80.

What are some biomarkers of aging, and how might they provide a more accurate picture of a patient’s functional status than chronological age?

You can also look at things that we [as a society] don't typically think of as biomarkers of aging, like your oxygen extraction efficiency. For instance, if you take a group of women who are 50 and put them on a bicycle, having them breathe oxygen, they will extract a certain amount of oxygen at a very high level of activity. But if you take those same women and give them all chemotherapy at 50, they will not be able to extract as much oxygen. Chemotherapy has really biologically aged them, because as we get older, you can plot a very clear curve showing that the older we get, the less oxygen we can extract from our blood. So, oxygen extraction efficiency is a biomarker of aging.

If you have two 75-year-olds and know the normal population level, you might see one woman who can't extract much oxygen from her blood, and that will frequently reflect how far she can walk, whether she can push a chair across the room, drive, get out of the house, or carry groceries up the elevator.

A biomarker of aging is something we measure that correlates with your functional status but may be very different from your chronological age, which is your birthday. It's a fascinating area, and people are conducting all kinds of tests and studies to find markers. You can even measure your telomere length. Telomeres are small portions of your DNA that shorten as we age, and when they shorten, they don't allow the DNA to work as well.

You can pay around $1,000 to send your blood out, and they'll tell you your telomere length and estimate how many years you have left. I wouldn't recommend it; I think the tests are inaccurate and not worth the money. However, telomeres do, in a way, reflect your age, but it's very crude and was very popular a few years ago.

I think everyone wants to know how long they'll live, and there's really no good way to do that, especially if you're not wearing seat belts and smoking.

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Articles

Personalized treatment for older breast cancer patients requires considering factors beyond chronological age, such as functional capacity, social support, and comorbidities. Tools exist to predict life expectancy, aiding in treatment planning. Molecular aging, including senescent cells and biomarkers like oxygen extraction efficiency, influences treatment response and provides a more accurate picture of a patient's health than age alone. Understanding these factors helps tailor treatment discussions and decisions, despite the challenges of high-throughput medical environments.

Dr. Hyman B. Muss discusses the unique facets of care that should inform personalized treatment decision-making for older patients with breast cancer.

Personalized Breast Cancer Care for Older Adults Goes Beyond Age

Dr. Andrew M. Evens breaks down what it means to be an adolescent or young adult with lymphoma and how treatment differs from pediatric and adult care.

Understanding AYA Lymphoma Care and Why Treatment May Differ by Age

Being an adolescent or young adult patient with lymphoma often requires different, more specialized care than pediatric and adult patients, according to Dr. Andrew M. Evens.

In order to further delve into this topic, Evens sat down for an interview with CURE. He shared his insights on what makes lymphoma in this patient population so different from the cases that are diagnosed in children or older adults, as well as how how this impacts treatment planning.

Evens holds multiple positions, including deputy director for clinical services at Rutgers Cancer Institute of New Jersey; associate vice chancellor of Clinical Innovation & Data Analytics at Rutgers Health; system director of medical oncology, and oncology lead for RWJBarnabas-Rutgers Medical Group, RWJBarnabas Health; and professor of medicine at Rutgers Robert Wood Johnson Medical School, all located in New Brunswick, New Jersey.

When we say adolescent and young adults, or AYAs… at least through the lens of the National Institutes of Health, it [includes] patient’s aged 15 to 39 [years]. The reason that age range is so important is it tends to be an overlap between our pediatric oncologists, who obviously will treat children well below age 10 and even into their 20s and sometimes into their 30s, even though that official definition goes up to 39 — usually it won't be often above 30, but certainly into the 20s.

On the other hand, an adult oncologist like myself, with different training (you go to a pediatric program for pediatric oncology or internal medicine and hematology-oncology or radiation oncology), we will usually treat our youngest patients starting at age 18 years and above, with no upper age limit. That age range from 18 to the low 30s has an overlap, and that's important because it can sometimes lead to a disparity of viewpoints and recommendations, at least historically.

When it comes to treatment planning, that's always going to be a factor: is the AYA patient, whether with Hodgkin lymphoma or non-Hodgkin lymphoma (let's say a 25-year-old), seeing a pediatric oncologist or an adult oncologist? You would think it would be identical, but it often is not. Historically, we have treated patients not radically differently, but slightly differently, and slight differences can sometimes be really important.

It always [comes down to]: what is the diagnosis? What's the exact subtype of lymphoma? That's regardless of pediatric or adult. What's the stage, meaning, where is it in the body? That's similar, if not close to identical, between us, assessed with blood tests and a PET scan, a whole-body scan that we'll do. Then, it's about coming up with the best treatment based on that subtype of lymphoma and stage. Of course, we're always looking for a clinical trial.

When we say clinical trial, we don't mean experimental. We mean we're always trying to do better than the standard of care. If there's a certain standard of care, that's great. How can we do even better and/or with less side effects? So, just in terms of big-picture treatment planning, those are some of the really important components.

Transcript has been edited for clarity and conciseness.

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Linda Cohen is a survivor of small lymphocytic lymphoma and was diagnosed in 2009. Catch up on all of 

When I first entered the infusion room, I looked around and said to myself, “Is this really for me?” I couldn’t believe it. I had cancer, and now I needed treatment. It was a surreal moment — one that didn’t quite feel real. Over time, I underwent treatment on three separate occasions. Thankfully, each course had a clear beginning and, most importantly, a defined end. As tough as those treatments were, I got through them, and they helped me. I am not complaining. I was grateful then, and I still am.

But as time moved on, I began getting sinus infections more and more frequently. I often needed antibiotics just to keep things under control. Eventually, my doctor ran some tests and discovered that my antibody levels were far too low. That’s when he told me I would need something new — regular IVIG infusions, a treatment involving immunoglobulin antibodies to help boost my immune system.

I began entering the infusion room for something different: IVIG. This wasn’t a temporary plan —this was something I was now told I would need every four weeks for the rest of my life. That part was a little harder to swallow. I had to make the decision to accept this new normal, and that took some time. It’s not easy knowing you’ll be tethered to lifelong treatment. It’s certainly not fun having to get poked and prodded every month while nurses search for a “good vein.” That was until I met Angela.

Angela is more than a nurse. In many ways, she’s more like an angel — and fittingly, that word is part of her name. From the moment I met her, she made a lasting impression. Angela always greeted me with a warm smile and a genuine sense of interest. She didn’t just treat me as a patient; she took the time to know me as a person. It was clear from the beginning that she cared about building a relationship. She understood that I’d be returning every four weeks indefinitely, and she chose to invest in me. In return, I wanted to get to know her, too.

One of the many reasons I never had to worry when I found out Angela would be my nurse was because she was simply the best at what she did. She was gentle and confident when starting an IV — no small thing when you’re dealing with frequent infusions. On top of that, she remembered the little things that made a big difference. I’d had a couple of bad reactions to the infusion early on, and we learned that the IVIG was dripping too quickly. Angela remembered. Without me even saying anything, she would reassure me: “Don’t worry, Linda, I know you need it to go in slowly, so you don’t get a reaction.” That attention to detail and commitment to my comfort never went unnoticed.

Angela made every visit brighter. When I saw her walking toward me, my face would light up — I honestly felt like I’d won the lottery that day. There’s just something special about her. She never made me feel like her “work.” She treated me with dignity, compassion, and joy. Her kindness was evident in everything she did — from making sure I was warm enough, to asking if I needed a snack, to offering help getting to the restroom.

It takes a very special kind of person to become a nurse. But it takes an extraordinary one to make you feel seen, safe, and valued, even during some of your most vulnerable moments. Angela, thank you. Your support is the kind that stays with a person forever.

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A patient's journey through cancer treatment evolves into a lifelong regimen of IVIG infusions due to low antibody levels. Initially challenging, the transition is eased by the compassionate care of a nurse named Angela, who provides not only medical expertise but also emotional support. Angela's attention to detail, kindness, and ability to build a personal connection transform the infusion experience, making the patient feel valued and understood. This narrative highlights the profound impact healthcare professionals can have on patients' lives beyond their clinical duties.

After cancer, lifelong infusions were tough — until nurse Angela’s care and kindness reminded me that true support can last long after treatment ends.

A Thank You to Nurses and the Support That Lasts Beyond Cancer Care

Elraglusib plus gemcitabine and nab-paclitaxel significantly improved survival as a first-line treatment for metastatic pancreatic cancer in a global phase 2 trial.

Eraglusib in combination with gemcitabine and nab-paclitaxel achieved statistical significance in the first-line treatment of metastatic pancreatic ductal adenocarcinoma, according to data from the part 3B phase 2 Actuate-1801 trial which were shared in a news release from Actuate Therapeutics, Inc.

These topline results showed a statistically significant improvement in overall survival with the eraglusib combination compared with gemcitabine and nab-paclitaxel alone. Moreover, these data also highlight a substantial improvement in the median overall survival benefit for patients receiving the investigate treatment compared with previous results which were shared in December of 2024.

“Pancreatic cancer is one of the most aggressive and difficult-to-treat malignancies, where patients urgently need new therapeutic options,” said Daniel Schmitt, president and CEO of Actuate. “There have been no major advances in improving survival in first-line treatment of metastatic pancreatic cancer in over a decade. Demonstrating statistically significant increases in both median overall survival and percent of patients reaching one-year survival and beyond, along with a favorable risk-benefit profile in this phase 2 trial, further demonstrates elraglusib’s potential to shift the treatment paradigm in metastatic pancreatic ductal adenocarcinoma.

“We are incredibly excited to present the topline data at [the 2025 ASCO Meeting]. Based on the significant improvement in survival we have seen to date in the combination arm, we look forward to working with United States and European Union regulators in the second half of this year to map out the path to advancing elraglusib to new drug application and registration and making the drug available to patients as expeditiously as possible,” Schmitt continued.

The news release goes on to share that these data meet the primary end point of overall survival in the phase 2 trial study and confirmed a significant one-year survival rate. Moreover, the combination of elraglusib with gemcitabine and nab-paclitaxel also demonstrated a favorable risk-benefit profile (balance between efficacy and safety).

Key findings from the study will be shared in an oral presentation at the upcoming Annual Meeting of the American Society of Clinical Oncology (ASCO). The company has announced its intent to engage with regulatory authorities to advance the development of elraglusib and expedite its path toward potential approval.

The presentation is entitled "Preliminary results from the randomized phase 2 study (1801 part 3B) of elraglusib in combination with gemcitabine/nab-paclitaxel (GnP) versus GnP alone in patients (pts) with previously untreated metastatic pancreatic ductal adenocarcinoma (mPDAC)" and will be shared on Saturday, May 31, 2025, at 4:48 PM Central Daylight time. Dr. Devalingam Mahalingam will be presenting these data.

More Information on the Actuate-1801 Part 3B study

The Actuate-1801 Part 3B study is a randomized, controlled phase 2 clinical trial designed to evaluate the efficacy and safety of elraglusib in combination with gemcitabine and nab-paclitaxel compared with gemcitabine and nab-paclitaxel alone for the first-line treatment of metastatic pancreatic ductal adenocarcinoma. A total of 286 patients with previously untreated metastatic disease were enrolled and randomized to receive either the elraglusib combination or gemcitabine and nab-paclitaxel alone. Patients treated with the combination received elraglusib at a dose of 9.3 milligrams per kilogram on day 1 of each week within a 28-day treatment cycle.

In addition to the primary end point of median overall survival, key secondary end points include disease control rate, objective response rate, progression-free survival, and incidence of side effects.

Importantly, elraglusib functions as an inhibitor of glycogen synthase kinase-3 beta (GSK-3β), a protein involved in cancer progression. Inhibition of GSK-3β has the ability to inhibit tumor growth and improve survival. This is done through several mechanisms which include enhancement of chemotherapy activity, activation of innate anti-tumor immunity and regulation of gene expression.

The combination of eraglusib with gemcitabine and nab-paclitaxel has shown statistically significant improvements in overall survival for patients with metastatic pancreatic ductal adenocarcinoma, according to the Actuate-1801 phase 2 trial. This combination therapy demonstrated a favorable risk-benefit profile and a significant one-year survival rate, marking a potential shift in the treatment paradigm for this aggressive cancer. Actuate Therapeutics plans to present these findings at the 2025 ASCO Meeting and engage with regulatory authorities to expedite the drug's approval process.

Eraglusib with gemcitabine and nab-paclitaxel achieved statistical significance in the first-line treatment of metastatic pancreatic ductal adenocarcinoma.

Ryan Scott

Personalized Breast Cancer Care for Older Adults Goes Beyond Age

Understanding AYA Lymphoma Care and Why Treatment May Differ by Age

A Thank You to Nurses and the Support That Lasts Beyond Cancer Care

Eraglusib Combo Improves Survival in Metastatic Pancreatic Cancer

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