Bridging The Age Gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer
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Published:2021-05-10
Issue:2
Volume:125
Page:209-219
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ISSN:0007-0920
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Container-title:British Journal of Cancer
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language:en
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Short-container-title:Br J Cancer
Author:
Ring AlistairORCID, Battisti Nicolò Matteo LucaORCID, Reed Malcolm W. R., Herbert Esther, Morgan Jenna L., Bradburn Michael, Walters Stephen J., Collins Karen A., Ward Sue E.ORCID, Holmes Geoffrey R., Burton Maria, Lifford Kate, Edwards Adrian, Robinson Thompson G., Martin Charlene, Chater Tim, Pemberton Kirsty J., Brennan Alan, Cheung Kwok Leung, Todd Annaliza, Audisio Riccardo A., Wright Juliet, Simcock Richard, Green Tracey, Revell Deirdre, Gath Jacqui, Horgan Kieran, Holcombe Chris, Winter Matthew C., Naik Jay, Parmeshwar Rishi, Gosney Margot A., Hatton Matthew Q., Thompson Alastair M., Wyld LyndaORCID, Collins Karen, Ward Sue, Holmes Geoff, Morgan Jenna, Bradburn Mike, Walters Stephen, Burton Maria, Lifford Kate, Edwards Adrian, Brain Kate, Ring Alistair, Robinson Thomson, Pemberton Kirsty, Shrestha Anne, Nettleship Anthony, Richards Paul, Cheung Kwok Leung, Harder Helena, Audisio Riccardo, Battisti Nicolò Matteo Luca, Wright Juliette, Simcock Richard, Murray Chris, Thomson Alistair M., Gosney Margot, Hatton Matthew, Armitage Fiona, Patnick Julietta, Green Tracy, Revill Deirdre, Gath Jacqui, Horgan Kieran, Holcombe Chris, Winter Matt,
Abstract
Abstract
Background
Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy.
Methods
A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage.
Results
Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19–0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20–0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08–0.49];BCSS: HR 0.12 [95% CI 0.03–0.44]).Transient negative quality-of-life impacts were observed.
Conclusions
Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient.
Trial Registration
ISRCTN 46099296
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Oncology
Reference35 articles.
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