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
Alistair Ring, Nicolò Matteo Luca Battisti, Malcolm Reed, Esther Herbert, Jenna Morgan, Michael Bradburn, Stephen J. Walters, Karen Collins, Sue Ward, Geoffrey R. Holmes, Maria Burton, Kate Lifford, Adrian Edwards, Thompson Robinson, Charlene Martin, Tim Chater, Kirsty Pemberton, Alan Brennan, Kwok‐Leung Cheung, Annaliza Todd, Riccardo A. Audisio, Juliet Wright, Richard Simcock, Tracey Green, Deirdre Revell, Jacqui Gath, Kieran Horgan, Chris Holcombe, Matthew Winter, Jay Naik, Rishikesh Parmeshwar, Margot Gosney, M. Hatton, Alastair M. Thompson, Lynda Wyld, on behalf of the Age Gap TMG, Karen Collins, Sue Ward, Geoffrey R. Holmes, Jenna Morgan, Mike Bradburn, Stephen J. Walters, Maria Burton, Kate Lifford, Adrian Edwards, Kate Brain, Alistair Ring, Thompson Robinson, Kirsty Pemberton, Anne Shrestha, Anthony Nettleship, Paul Richards, Kwok‐Leung Cheung, Helena Harder, Riccardo A. Audisio, Nicolò Matteo Luca Battisti, Juliette Wright, Richard Simcock, Chris Murray, Alistair M. Thomson, Margot Gosney, M. Hatton, Fiona Armitage, Julietta Patnick, Tracy Green, Deirdre Revill, Jacqui Gath, Kieran Horgan, Chris Holcombe, Matthew Winter
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.