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Observational Study
. 2021 Jul;125(2):209-219.
doi: 10.1038/s41416-021-01388-9. Epub 2021 May 10.

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 #  1 , Nicolò Matteo Luca Battisti #  1 , Malcolm W R Reed  2 , Esther Herbert  3 , Jenna L Morgan  4 , Michael Bradburn  3 , Stephen J Walters  3 , Karen A Collins  5 , Sue E Ward  6 , Geoffrey R Holmes  6 , Maria Burton  5 , Kate Lifford  7 , Adrian Edwards  7 , Thompson G Robinson  8 , Charlene Martin  4 , Tim Chater  3 , Kirsty J Pemberton  3 , Alan Brennan  6 , Kwok Leung Cheung  9 , Annaliza Todd  4 , Riccardo A Audisio  10 , Juliet Wright  2 , Richard Simcock  11 , Tracey Green  12 , Deirdre Revell  12 , Jacqui Gath  12 , Kieran Horgan  13 , Chris Holcombe  14 , Matthew C Winter  15 , Jay Naik  16 , Rishi Parmeshwar  17 , Margot A Gosney  18 , Matthew Q Hatton  15 , Alastair M Thompson  19 , Lynda Wyld  20 ; Age Gap TMG
Collaborators, Affiliations
Observational Study

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 et al. Br J Cancer. 2021 Jul.

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.

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Conflict of interest statement

The authors declare no competing interests. Professors Stephen Walters and Thompson Robinson are National Institute for Health Research (NIHR) Senior Investigators, Jenna Morgan is a NIHR Clinical Lecturer and Kate Lifford is funded by the NIHR as part of this project. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care.

Figures

Fig. 1
Fig. 1. STROBE diagram.
STROBE flow diagram for the chemotherapy vs no chemotherapy analyses.
Fig. 2
Fig. 2. Kaplan–Meier plots of survival and metastatic recurrence outcomes.
a Overall Survival in unmatched high-risk patients (n = 1495). Adjusted HR 0.87 (95% CI 0.58–1.28, p = 0.47). b Overall survival in matched high-risk patients (n = 542). Adjusted HR 0.79 (95% CI: 0.50–1.26, p = 0.32). c Breast cancer-specific survival in unmatched high-risk patients (n = 1486). Adjusted HR 0.92 (95% CI: 0.56–1.53, p = 0.76). d Breast cancer-specific survival in matched high-risk patients (n = 539). Adjusted HR 0.93 (95% CI: 0.52–1.66, p = 0.80). e Metastatic recurrence in unmatched high-risk patients (n = 1498). Adjusted HR 0.36 (95% CI: 0.19–0.68, p = 0.002). f Metastatic recurrence in matched high-risk patients (n = 541). Adjusted HR 0.53 (95% CI: 0.26–1.07, p = 0.08).
Fig. 3
Fig. 3. Kaplan–Meier plots for survival outcomes in matched patients with HER2-positive or ER-negative breast cancer.
a Overall survival in patients with HER2-positive breast cancer (n = 137): HR 0.63 [0.27–1.48]; and in patients with ER-negative breast cancer (n = 136): HR 0.20 [0.08–0.49]. b Breast cancer-specific survival in patients with HER2-positive breast cancer (n = 137): HR 0.5 [0.16–1.63]; and in patients with ER-negative breast cancer (n = 135): HR 0.12 [0.03–0.44].
See this image and copyright information in PMC

References

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