As reported in the Journal of Clinical Oncology by Ji et al, the HOPE study (Hurria Older Patients [HOPE] with Breast Cancer Study) has shown that older women categorized as robust prior to adjuvant chemotherapy are at risk for clinical decline postchemotherapy, with high baseline levels of the inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) being associated with significantly increased risk.
Study Details
The current analysis included 295 women aged ≥ 65 years with stage I to III breast cancer who were characterized as robust on a Deficit Accumulation Index (DAI) prior to adjuvant chemotherapy (T1). IL-6 and CRP levels were measured at T1; the cutoff for high vs low were the median values of 2.5 pg/mL for IL-6 and 3.5 mg/L for CRP. The primary outcome measure was chemotherapy-induced decline in frailty status, defined as decline in DAI from robust at T1 to prefrail or frail at T2 (up to 30 days after chemotherapy).
Key Findings
Of the 295 women categorized as robust at T1, 76 (26%) had a chemotherapy-induced decline in frailty status to prefrail (n = 69, 23%) or frail (n = 7, 2%) at T2.
Patients with vs without a decline in frailty status had significantly higher baseline levels of IL-6 (median = 3.57 pg/mL vs 2.15 pg/mL, P = .003) and CRP (median = 4.75 mg/L vs 3.06 mg/L, P = .007). Among the 76 with decline, 65.8% had high IL-6 levels and 63.2% high CRP levels. A total of 46.1% had high levels of both markers, compared with 25.6% of patients who remained robust.
In multivariate analysis adjusting for sociodemographic and clinical characteristics, women with both high baseline IL-6 and high CRP had a significantly increased risk of decline in frailty status (odds ratio [OR] = 3.52, 95% confidence interval [CI] = 1.55–8.01, P = .003) compared with women with low baseline IL-6 and CRP. Odds ratios were 1.26 (95% CI = 0.48–3.35, P =. 64) among women with low IL-6 and high CRP and 1.77 (95% CI = 0.72–4.35, P = .21) among those with high IL-6 and low CRP.
The investigators concluded, “In this cohort of older women with early breast cancer who were clinically fit before chemotherapy initiation, high IL-6 and CRP prechemotherapy were associated with chemotherapy-induced decline in frailty status independent of sociodemographic and clinical risk factors. Further research is needed to examine whether inflammatory markers can inform more personalized approaches to treating older breast cancer survivors.”
Mina S. Sedrak, MD, MS, of City of Hope National Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Institute on Aging, Breast Cancer Research Foundation, Center of Cancer and Aging, and National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
