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

Ring, Alistair, Battisti, Nicolò Matteo Luca, Reed, Malcolm W. R., Herbert, Esther, Morgan, Jenna L., Bradburn, Michael, Walters, Stephen J., Collins, Karen A., Ward, Sue E., Holmes, Geoffrey R., Burton, Maria, Lifford, Kate ORCID: https://orcid.org/0000-0002-9782-2080, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446, 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. and Wyld, Lynda 2021. 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. British Journal of Cancer 125 , pp. 209-219. 10.1038/s41416-021-01388-9

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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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Nature Publishing Group
ISSN:	0007-0920
Date of First Compliant Deposit:	23 June 2021
Date of Acceptance:	31 March 2021
Last Modified:	27 Nov 2023 07:24
URI:	https://orca.cardiff.ac.uk/id/eprint/142147

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