1. 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.
- Author
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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, and Wyld L
- Subjects
- Aged, Aged, 80 and over, Anthracyclines adverse effects, Breast Neoplasms psychology, Bridged-Ring Compounds adverse effects, Drug Therapy, Female, Humans, Patient Satisfaction statistics & numerical data, Propensity Score, Prospective Studies, Survival Analysis, Taxoids adverse effects, Trastuzumab adverse effects, Treatment Outcome, Anthracyclines therapeutic use, Breast Neoplasms drug therapy, Bridged-Ring Compounds therapeutic use, Quality of Life psychology, Taxoids therapeutic use, Trastuzumab therapeutic use
- 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., (© 2021. The Author(s).)
- Published
- 2021
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