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Real-world evaluation of effectiveness and tolerance of chemotherapy for early-stage breast cancer in older women

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Abstract

Purpose

Older patients with early-stage breast cancer (ESBC) tend to receive less aggressive treatment, have higher mortality rates, and are underrepresented in clinical trials. Outcomes, tolerance and toxicity of chemotherapy are underreported. Thus, we assessed the outcomes of chemotherapy in the real-world in a community oncology setting.

Methods

We retrospectively chart reviewed consecutive older patients (≥ 70 years) with ESBC diagnosed between January 1, 2010, and December 31, 2016, who received chemotherapy at our institution. Study outcomes were survival estimates. Logistic regression determined associations with measures of intolerance.

Results

Of 1296 patients, 229 received chemotherapy. Overall, 24% had early chemotherapy cessation; 18% had dose reductions; and 27% had dose delays. Severe, life threatening and lethal toxicities occurred in 38%, 1.3%, and 2.2%, respectively; constitutional toxicity (37%) was the most common. The 1- and 3-year overall survivals were 94% and 79%; 1- and 3-year breast-specific survivals were 96% and 89%, while 1- and 3-year disease-free survivals were 95% and 82%, respectively. Anthracyclines were the most poorly tolerated regimen having associations with hospital visits (OR 10.97, 95% CI 2.10–57.23) and severe toxicities (OR 5.28, 95% CI 1.27–21.89). Anti-HER2 therapies (OR 3.03, 95% CI 1.18–7.78) and poorer performance status (PS) (OR 7.48, 95% CI 1.75–31.98) were associated with severe toxicities. Older age (> 80 years) was associated with early cessation of therapy (OR 3.64, 95% CI 1.34–9.83).

Conclusions

Chemotherapy can be effectively delivered to older patients with ESBC and is reasonably well tolerated. The high rate of anthracycline intolerability, poorer PS, and advanced age should be considered when tailoring treatment regimens.

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Acknowledgements

We acknowledge the contributions on data analysis performed by Dr. Thomas G. Cotter, MD from the University of Chicago Medical Center; and the Biostatistics, Epidemiology, and Research Design (BERD) Unit from the University of Tennessee Health Sciences Center, including Qi Zhao, Patricia Goedecke, and Vikki Nolan.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Glenda M. Delgado-Ramos

  2. Division of Hematology/Oncology, West Cancer Center/University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, Memphis, TN, USA

    Syed Sameer Nasir & Lee S. Schwartzberg

  3. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Jiajing Wang

  4. Division of Hematology/Oncology, Loyola University Medical Center, Chicago, IL, USA

    Glenda M. Delgado-Ramos

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  1. Glenda M. Delgado-Ramos
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  2. Syed Sameer Nasir
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  4. Lee S. Schwartzberg
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Contributions

Study concepts: GD-R, LS; study design: GD-R, LS; data acquisition: GD-R, SN, LS; quality control of data algorithms: JW; data analysis and interpretation: GD-R, SN, LS; statistical analysis: JW; manuscript preparation: GD-R; manuscript editing: LS; manuscript review: GD-R, SN, JW, LS.

Corresponding author

Correspondence to Lee S. Schwartzberg.

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Conflict of interest

Glenda Delgado-Ramos, Sameer Nasir, Jiajing Wang declare that they have no conflict on interest. Lee Schwartzberg—Consultant: Pfizer, Amgen, Napo, Genentech/Roche, Myriad, AstraZeneca, Genomic Health, GSK, BMS, Helsinn, Novartis. Research Support: Amgen, Pfizer.

Ethical approval

This was a retrospective study involving patients who received standard of care treatment as per best evidence-based approaches and per society guidelines. It was in accordance with the ethical standards of the institution.

Informed consent

This was a retrospective chart review and thus informed consent of individual participants was not required.

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Delgado-Ramos, G.M., Nasir, S.S., Wang, J. et al. Real-world evaluation of effectiveness and tolerance of chemotherapy for early-stage breast cancer in older women. Breast Cancer Res Treat 182, 247–258 (2020). https://doi.org/10.1007/s10549-020-05684-5

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  • DOI: https://doi.org/10.1007/s10549-020-05684-5

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