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Little Benefit From Adjuvant Chemo for Many Older Breast Cancer Patients
Among older women with early-stage, estrogen-receptor-positive breast cancer whose tumors indicate a high risk of recurrence, only those ages 65-74 without severe comorbidity may receive small benefits from adjuvant chemotherapy.
Women ages 65-69 and 70-74 with no/low or moderate comorbidity gained 0.16 quality of life years with chemoendocrine therapy.
The magnitude of the gains decreased as comorbidity level and age group increased.
For women ages 75 and older, there was no gain in quality of life years in any comorbidity group with chemoendocrine therapy.
Grade 3-4 toxicity rates ranged from 12.8% in the youngest age, lowest comorbidity-level group to 24.5% in the oldest age group with severe comorbidity.
Older women were more likely to die of causes other than breast cancer.
With adjuvant chemotherapy, breast cancer mortality among women 65-69 and no/low comorbidity was reduced from 34.8% to 29.7%; however, this benefit was associated with a 12.8% rate of grade 3/4 toxicity.
Mortality reductions decreased with increasing age and comorbidity level.
Rates of distant recurrence among patients with high (score of 31 or higher), intermediate (18 or higher, but less than 31), and low (less than 18) risk were 30.5%, 14.3%, and 6.8%, respectively.
The majority of the patients identified with high recurrence risk did not have a distant recurrence within 10 years.
The study affirms the fact that for older women with estrogen receptor-positive breast cancer there is little benefit from adjuvant chemotherapy.
Adjuvant hormonal therapy is both a standard treatment and highly beneficial.
High-dose chemotherapy in the adjuvant setting offers a long-term survival advantage for women with very-high-risk stage III breast cancer, but does not improve survival odds for women with lower-risk cancers, an analysis of 20 years of follow-up data shows.
Among 885 women younger than 56 years at the time of treatment who had 4 or more involved axilliary lymph nodes, there was no overall survival difference over 2 decades between the total population of women randomized to receive adjuvant high-dose chemotherapy (HDCT) and those assigned to receive conventional-dose chemotherapy (CDCT).
However, women with 10 or more involved axilliary nodes and those with triple-negative breast cancer had an approximately 15% absolute improvement in 20-year overall survival with high-dose chemotherapy, although the difference for triple-negative disease fell just short of statistical significance.
(Netherlands Cancer Institute).
HDCT has no significant overall survival benefit compared with CDCT for unselected patients with stage III breast cancer.
However, we found a 14.6%improvement in 20-year OS estimates with HDCT in the predefined subgroup of patients with 10 or more lymph nodes involved.
After a median follow-up of 20.4 years, the 20-year overall survival (OS) rates were 45.3% for patients who had received high-dose chemotherapy and 41.5% for those who had received the conventional dose: nonsignificant hazard ratio of 0.89.
For patients with 10 or more involved axillary nodes, the 20-year OS rates were 44.5% with HDCT and 29.9% with CDCT, translating into an absolute OS advantage for high-dose chemotherapy of 14.6% and an HR of 0.72.
A delay in neoadjuvant systemic chemotherapy initiation of more than 61 days after breast cancer diagnosis is associated with an increased risk of death (Chavez-MacGregor)