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.
Date
2021-07-20ICR Author
Author
Ring, A
Battisti, NML
Reed, MWR
Herbert, E
Morgan, JL
Bradburn, M
Walters, SJ
Collins, KA
Ward, SE
Holmes, GR
Burton, M
Lifford, K
Edwards, A
Robinson, TG
Martin, C
Chater, T
Pemberton, KJ
Brennan, A
Cheung, KL
Todd, A
Audisio, RA
Wright, J
Simcock, R
Green, T
Revell, D
Gath, J
Horgan, K
Holcombe, C
Winter, MC
Naik, J
Parmeshwar, R
Gosney, MA
Hatton, MQ
Thompson, AM
Wyld, L
Age Gap TMG
Type
Journal Article
Metadata
Show full item recordAbstract
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.
Collections
Subject
Aged
Aged, 80 and over
Anthracyclines
Breast Neoplasms
Bridged-Ring Compounds
Drug Therapy
Female
Humans
Patient Satisfaction
Propensity Score
Prospective Studies
Quality of Life
Survival Analysis
Taxoids
Trastuzumab
Treatment Outcome
Research team
Breast Cancer Clin Res
Language
eng
Date accepted
2021-03-31
License start date
2021-07-20
Citation
British Journal of Cancer, 2021, 125 (2), pp. 209 - 219
Publisher
SPRINGERNATURE