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Expect Questions About Adjuvant Chemotherapy for Older Women


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Two recent studies found significant survival benefits for patients older than 70 years with surgically treated nonmetastatic triple-negative breast cancer who also received chemotherapy.1,2 The authors of both studies concluded that the findings support the consideration of chemotherapy for older women with triple-negative breast cancer.

“We finally have some concrete numbers to share with patients,” said Jennifer A. Crozier, MD, of Baptist MD Anderson Cancer Center, Jacksonville, Florida, and lead author of one of these studies, in an interview with The ASCO Post. “We can go over these survival numbers and help patients decide if these numbers are reasonable enough for them. Some patients might choose chemotherapy even for a 1% difference in survival, whereas others might be willing to go that route even for a 20% difference in survival,” Dr. Crozier noted.

“Some patients just say ‘no,’” she acknowledged, but many times that is based on anecdotal reports from a friend or relative who had a particularly nasty experience with chemotherapy. In those cases, patients can be reminded that chemotherapy is not always the ordeal it once was.

“We always try to encourage patients—especially with this type of breast cancer that is so aggressive and tends to come back as incurable metastatic disease—to start chemotherapy. We can always stop it if we have to,” she said.

Looking Beyond Age

“Chemotherapy is particularly important for triple-negative breast cancer,” Dr. Crozier said, “because there are no targeted therapies available. We are limited to chemotherapy at this time.”

The survival results must be weighed against potential toxicities. “Even healthy older women [for whom chemotherapy is recommended] will not tolerate the treatment as well as younger women, since there is an increased likelihood of potential side effects, hospital admissions, and short-term mortality in this population,” Dr. Crozier and colleagues wrote.1 “Additionally, competing causes of death increase with increasing age.”

But it is not all about age. “Women are living longer, and they are healthier,” Dr. Crozier remarked. When discussing treatment options with older patients, she said, “Some patients will look at us and say, ‘You do realize I am 70 (or 75)?’ And I say, ‘Yes, but you were at tennis practice this morning, you are taking your cholesterol medications, and there are patients who are younger than you who have way more medical problems.’ It is really looking at where that person is healthwise at that point in time. Age comes into play, of course, but I think we need to look beyond age.”

Are women receiving a mixed message, with some cancer screening guidelines suggesting stopping or decreasing the frequency of detection tests for older women, but studies suggesting more aggressive treatment? Dr. Crozier stressed that “screening is always a joint decision between you and your physician, based on your health.” Specifically concerning mammography, Dr. Crozier noted, “our recommendation here is, if you are healthy enough to undergo surgery for breast cancer, then we think you should still be receiving mammograms.” 

DISCLOSURE: Dr. Crozier has served as a consultant or advisor to Novartis and Puma Biotechnology, has participated in a speakers bureau for Agendia, and has received institutional research funding from Agendia and Seattle Genetics

REFERENCES

1. Crozier JA, Pezzi TA, Hodge C, et al: Addition of chemotherapy to local therapy in women aged 70 years or older with triple-negative breast cancer: A propensity-matched analysis. Lancet Oncol 21:1611-1619, 2020.

2. Janeva S, Zhang C, Kovacs A, et al: Adjuvant chemotherapy and survival in women aged 70 years and older with triple-negative breast cancer: A Swedish population-based propensity score-matched analysis. Lancet Healthy Longevity, November 30, 2020 (early release online).


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