Is adjuvant chemotherapy necessary in older patients with breast cancer?

Abstract

Background Due to the lack of clinical trials on the efficacy of chemotherapy in older patients, an optimal treatment strategy has not been developed. We investigated whether adjuvant chemotherapy could improve the survival of older patients with breast cancer in Japan. Methods We retrospectively analyzed data of patients with breast cancer aged ≥ 70 years who underwent breast cancer surgery in eight hospitals between 2008 and 2013. Clinical treatment and follow-up data were obtained from the patients’ medical electric records. Results A total of 1095 patients were enrolled, of which 905 were included in the initial non-matched analysis. The median age and follow-up period were 75 (range 70–93) and 6.3 years, respectively. Of these patients, 127 (14%) received adjuvant chemotherapy (Chemo group) while the remaining 778 (86%) did not (Control group). The Chemo group was younger (mean age in years 73 vs 76; P < 0.0001), had a larger pathological tumor size (mean mm 25.9 vs 19.9; P < 0.0001), and more metastatic axillary lymph nodes (mean numbers 2.7 vs 0.7; P < 0.0001) than the Control group. The disease-free survival (DFS) and overall survival (OS) did not differ significantly between the two groups (P = 0.783 and P = 0.558). After matched analyses, DFS was found to be significantly prolonged with adjuvant chemotherapy (P = 0.037); however, OS difference in the matched cohort was not statistically significant (P = 0.333). Conclusion The results showed that adjuvant chemotherapy was associated with a reduced risk of recurrence, but survival benefits were limited.

Advocate-BREAST80+: A Comprehensive Patient and Advocate-Led Study to Enhance Breast Cancer Care Delivery and Patient-Centered Research in Women aged ≥ 80 years

“…The reasons for therapy decline in older patients may include duration of therapy, perceived unclear benefit of therapy, concerns regarding the potential for therapies to exacerbate preexisting medical conditions and/or cause new problems, financial concerns, and communication barriers (e.g., hearing or visual impairments that make it difficult to understand the benefits of a given cancer treatment) [12,13]. While avoidance of potentially toxic therapies is often appropriate in BC P80+ as risks may outweigh benefits, some older BC patients do benefit from adjuvant chemotherapy [14,15]. The ADVANCE (ADjuVANt Chemotherapy in the Elderly) trial assessed the feasibility of two (neo)adjuvant chemotherapy regimens in parallel-enrolling cohorts of older persons (≥ 70 years) with human epidermal growth factor receptor 2 (HER2)-negative BC [16].…”

Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database

“…Most recently, Morita et al. conducted a retrospective multicenter study in Japan ( 27 ). However, they did not find any significant difference in OS among older patients who received adjuvant chemotherapy or not (p = 0.333).…”

A novel nomogram for predicting long-term heart-disease specific survival among older female primary breast cancer patients that underwent chemotherapy: A real-world data retrospective cohort study

“…Nonetheless, its use can reportedly cause cardiac side effects, including cardiomyopathy, ischemia, arrhythmias, and myocardial necrosis, resulting in severe and irreversible left ventricular dysfunction ( 16 , 17 ). Two main mechanisms can explain this cardiotoxicity: (i) anthracyclines cause myocyte DNA damage, bind to topoisomerase IIβ and disrupt replication ( 18 , 19 ); (ii) anthracyclines form complexes with intracellular iron, which in turn generate reactive oxygen species that damage DNA, proteins, and lipids, including mitochondrial membranes, and accelerate myocyte death ( 20 , 21 ). In this regard, Howard et al showed that doxorubicin-based adjuvant chemotherapy for breast cancer could cause arrhythmias and conduction abnormalities in 2.6% of patients compared to 1% of patients who did not receive doxorubicin ( 4 ).…”