Nina Tamirisa1, Heather Lin2, Yu Shen2, Simona F Shaitelman3, Meghan S Karuturi4, Sharon H Giordano4,5, Gildy V Babiera6, Isabelle Bedrosian1. 1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. MD Anderson Physician Network, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: Data are lacking about the benefit of adjuvant endocrine therapy (ET) in older patients with multiple comorbidities. The authors sought to determine the effect of ET on the survival of older patients who had multiple comorbidities and estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, pathologic node-negative (pN0) breast cancer. METHODS: Women aged ≥70 years in the National Cancer Database (2010-2014) with Charlson/Deyo comorbidity scores of 2 or 3 who had pathologic tumor (pT1)-pT3/pN0, ER-positive/HER2-negative breast cancer were divided into 2 cohorts: adjuvant ET and no ET. Propensity scores were used to match patients based on age, comorbidity score, facility type, pT classification, chemotherapy, surgery, and radiation therapy. A Cox proportional hazards model was used to estimate the effect of ET on overall survival (OS). RESULTS: In the nonmatched cohort (n = 3716), 72.8% of patients received ET (n = 2705), and 27.2% did not (n = 1011). The patients who received ET were younger (mean age, 76 vs 79 years; P < .001) and had higher rates of breast conservation compared with those who did not receive ET (lumpectomy plus radiation: 43.4% vs 23.8%, respectively; P < .001). In the matched cohort (n = 1972), the median OS was higher in the ET group (79.2 vs 67.7 months; P < .0001). In the adjusted analysis, ET was associated with improved survival (hazard ratio, 0.70; 95% CI, 0.59-0.83). CONCLUSIONS: In older patients who have pN0, ER-positive/HER2-negative breast cancer with comorbidities, adjuvant ET was associated with improved OS, which may have been overestimated given the confounders inherent in observational studies. To optimize outcomes in these patients, current standard recommendations should be considered stage-for-stage based on life expectancy and the level of tolerance to treatment.
BACKGROUND: Data are lacking about the benefit of adjuvant endocrine therapy (ET) in older patients with multiple comorbidities. The authors sought to determine the effect of ET on the survival of older patients who had multiple comorbidities and estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, pathologic node-negative (pN0) breast cancer. METHODS: Women aged ≥70 years in the National Cancer Database (2010-2014) with Charlson/Deyo comorbidity scores of 2 or 3 who had pathologic tumor (pT1)-pT3/pN0, ER-positive/HER2-negative breast cancer were divided into 2 cohorts: adjuvant ET and no ET. Propensity scores were used to match patients based on age, comorbidity score, facility type, pT classification, chemotherapy, surgery, and radiation therapy. A Cox proportional hazards model was used to estimate the effect of ET on overall survival (OS). RESULTS: In the nonmatched cohort (n = 3716), 72.8% of patients received ET (n = 2705), and 27.2% did not (n = 1011). The patients who received ET were younger (mean age, 76 vs 79 years; P < .001) and had higher rates of breast conservation compared with those who did not receive ET (lumpectomy plus radiation: 43.4% vs 23.8%, respectively; P < .001). In the matched cohort (n = 1972), the median OS was higher in the ET group (79.2 vs 67.7 months; P < .0001). In the adjusted analysis, ET was associated with improved survival (hazard ratio, 0.70; 95% CI, 0.59-0.83). CONCLUSIONS: In older patients who have pN0, ER-positive/HER2-negative breast cancer with comorbidities, adjuvant ET was associated with improved OS, which may have been overestimated given the confounders inherent in observational studies. To optimize outcomes in these patients, current standard recommendations should be considered stage-for-stage based on life expectancy and the level of tolerance to treatment.
Authors: N Nabieva; S Kellner; T Fehm; L Häberle; J de Waal; M Rezai; B Baier; G Baake; H-C Kolberg; M Guggenberger; M Warm; N Harbeck; R Wuerstlein; J-U Deuker; P Dall; B Richter; G Wachsmann; C Brucker; J W Siebers; N Fersis; T Kuhn; C Wolf; H-W Vollert; G-P Breitbach; W Janni; R Landthaler; A Kohls; D Rezek; T Noesselt; G Fischer; S Henschen; T Praetz; V Heyl; T Kühn; T Krauss; C Thomssen; A Hohn; H Tesch; C Mundhenke; A Hein; C Rauh; C M Bayer; A Jacob; K Schmidt; E Belleville; S Y Brucker; S Kümmel; M W Beckmann; D Wallwiener; P Hadji; P A Fasching Journal: Ann Oncol Date: 2018-01-01 Impact factor: 32.976
Authors: Hyman B Muss; Dongsheng Tu; James N Ingle; Silvana Martino; Nicholas J Robert; Joseph L Pater; Timothy J Whelan; Michael J Palmer; Martine J Piccart; Lois E Shepherd; Kathleen I Pritchard; Zhi He; Paul E Goss Journal: J Clin Oncol Date: 2008-03-10 Impact factor: 44.544
Authors: Diana Crivellari; Zhuoxin Sun; Alan S Coates; Karen N Price; Beat Thürlimann; Henning Mouridsen; Louis Mauriac; John F Forbes; Robert J Paridaens; Monica Castiglione-Gertsch; Richard D Gelber; Marco Colleoni; István Láng; Lucia Del Mastro; Laurence Gladieff; Manuela Rabaglio; Ian E Smith; Jacquie H Chirgwin; Aron Goldhirsch Journal: J Clin Oncol Date: 2008-03-10 Impact factor: 44.544
Authors: Melisa L Wong; Timothy L McMurry; Jessica R Schumacher; Chung-Yuan Hu; George J Stukenborg; Amanda B Francescatti; Caprice C Greenberg; George J Chang; Daniel P McKellar; Louise C Walter; Benjamin D Kozower Journal: J Oncol Pract Date: 2018-09-12 Impact factor: 3.840