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Early breast cancer patients receiving no adjuvant therapy have poorer outcomes

Key clinical point: Local recurrence-free survival (RFS) is worst in women older than 70 years with early breast cancer who do not receive adjuvant therapy.

Major finding: Patients receiving adjuvant therapy had improved local RFS vs. those receiving no adjuvant treatment (at 5 and 10 years, endocrine: 95.8% and 95.8%; radiation: 98.5% and 94.8%; both endocrine and radiation: 99.2% and 99.2%; and no adjuvant therapy: 88.0% and 84.6%, respectively).

Study details: The data come from a retrospective cohort study of 460 patients (age, >70 years with early breast cancer) in the Nova Scotia Cancer Registry database.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Commentary

“Studies have shown that older women diagnosed with breast cancer tend to receive less aggressive therapy compared with younger women. Comorbidities and performance status are variable in older women, and many are relatively fit and good candidates for treatment. Endocrine therapy reduces recurrence risk and breast cancer-related mortality for estrogen receptor (ER)-positive disease. Aromatase inhibitors are generally favoured in post-menopausal women, and clinicians have responsibility to address side effects including arthralgia, hot flashes and osteopenia/osteoporosis. Radiation therapy is associated with very good tolerability, however, some older women with small ER-positive, node-negative tumors may elect to forgo radiation if they intend to take endocrine therapy. Newer protocols, including accelerated partial breast irradiation, have been developed to further improve upon toxicity profile and delivery time. It is important for providers to acknowledge endocrine therapy and radiation benefits in older women, comorbidities, functional status and patient preferences, so appropriate treatment can be recommended.”

Erin Roesch, MD

The Cleveland Clinic

References:
Bastiaannet E, Liefers GJ, de Craen AJM, et al. Breast Cancer in Elderly Compared to Younger Patients in the Netherlands: Stage at Diagnosis, Treatment and Survival in 127,805 Unselected Patients. Breast Cancer Res Treat. 2010; 124(3):807-7.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Davies C, Godwin J, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011; 378(9793):771.
Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013; 31(19):2382.
Polgár C, Fodor J, Major T, et al. Breast‐conserving therapy with partial or whole breast irradiation: ten‐year results of the Budapest randomized trial. Radiother Oncol. 2013; 108(2):197‐202.

Citation:

Dahn H et al. Breast Cancer Res Treat. 2020 May 21. doi: 10.1007/s10549-020-05691-6.