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, A., BATTISTI, N.M.L., REED, M.W.R., HERBERT, E., MORGAN, J.L., BRADBURN, M., WALTERS, S.J., COLLINS, K.A., WARD, S.E., HOLMES, G.R., BURTON, Maria, LIFFORD, K., EDWARDS, A., ROBINSON, T.G., MARTIN, C., CHATER, T., 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., COLLINS, K., WARD, S., HOLMES, G., MORGAN, J., BRADBURN, M., WALTERS, S., BURTON, M., EDWARDS, A., BRAIN, K., RING, A., ROBINSON, T., PEMBERTON, K., SHRESTHA, A., NETTLESHIP, A., RICHARDS, P., CHEUNG, K.L., HARDER, H., AUDISIO, R., WRIGHT, J., SIMCOCK, R., MURRAY, C., THOMSON, A.M., GOSNEY, M., HATTON, M., ARMITAGE, F., PATNICK, J., GREEN, T., REVILL, D., HORGAN, K., HOLCOMBE, C. and WINTER, M. (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 (2), 209-219.

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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. Trial Registration: ISRCTN 46099296.

Item Type:	Article
Uncontrolled Keywords:	Age Gap TMG; Oncology & Carcinogenesis; 1112 Oncology and Carcinogenesis; 1117 Public Health and Health Services
Identification Number:	https://doi.org/10.1038/s41416-021-01388-9
Page Range:	209-219
SWORD Depositor:	Symplectic Elements
Depositing User:	Symplectic Elements
Date Deposited:	28 May 2021 12:23
Last Modified:	21 Jul 2021 09:00
URI:	https://shura.shu.ac.uk/id/eprint/28696

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