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.

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

Metadata

Item Type:	Article
Authors/Creators:	Ring, A. Battisti, N.M.L. Reed, M.W.R. Herbert, E. Morgan, J.L. Bradburn, M. https://orcid.org/0000-0002-3783-9761 Walters, S.J. https://orcid.org/0000-0001-9000-8126 Collins, K.A. Ward, S.E. Holmes, G.R. https://orcid.org/0000-0002-8861-9638 Burton, M. Lifford, K. Edwards, A. Robinson, T.G. Martin, C. Chater, T. https://orcid.org/0000-0002-1138-0147 Pemberton, K.J. Brennan, A. Cheung, K.L. Todd, A. Audisio, R.A. Wright, J. Simcock, R. Green, T. Revell, D. Gath, J. Horgan, K. Holcombe, C. Winter, M.C. Naik, J. Parmeshwar, R. Gosney, M.A. Hatton, M.Q. Thompson, A.M. Wyld, L. https://orcid.org/0000-0002-4046-5940 Age Gap TMG
Copyright, Publisher and Additional Information:	© The Author(s) 2021. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Dates:	Published: 20 July 2021 Published (online): 10 May 2021 Accepted: 31 March 2021
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research
Funding Information:	Funder Grant number NATIONAL INSTITUTE FOR HEALTH RESEARCH nan
Depositing User:	Symplectic Sheffield
Date Deposited:	20 May 2021 14:09
Last Modified:	28 Feb 2022 14:39
Status:	Published
Publisher:	Springer Nature
Refereed:	Yes
Identification Number:	10.1038/s41416-021-01388-9
Related URLs:	PubMed URL
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:174414

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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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