Chemotherapy Offers No Survival Benefit for Older breast Cancer Patients, Large Study Finds
A new study published in the Lancet by researchers at the Curie Institute suggests that adjuvant chemotherapy does not significantly improve survival rates in women aged 70 and over with high-risk, estrogen receptor-positive (ER+) breast cancer.The findings support a move towards less aggressive treatment strategies for this patient population.
The randomized phase III ASTER 70s trial, conducted across 84 centers in France and Belgium, involved 1,089 patients (median age 75.1) who had undergone surgery for primary or recurrent ER+ breast cancer. Patients were categorized as having high-risk tumors based on their genomic grade index (GGI), and approximately 40% were identified as having geriatric frailty.
Participants were randomly assigned to receive either four cycles of taxane or anthracycline-based chemotherapy followed by hormonal therapy (n=541),or hormonal therapy alone (n=548). After a median follow-up of 7.8 years, the study found no important difference in overall survival between the two groups. Four-year survival rates were 90.5% with chemotherapy versus 89.3% with hormonal therapy alone, and eight-year rates were 72.7% and 68.3%, respectively.
However, chemotherapy was associated with significantly more toxicity than hormonal therapy. Grade 3 or higher adverse effects occurred in 34% of patients receiving chemotherapy, compared to just 9% in the hormonal therapy-only group. Patients undergoing chemotherapy also reported a considerable decline in quality of life, experiencing fatigue, low white blood cell counts, anemia, fever, digestive issues, and reduced independence.
The authors conclude that these results support a strategy of “reasoned therapeutic de-escalation” for older patients with this type of breast cancer, suggesting that adjuvant chemotherapy should be reserved for carefully selected cases where it may offer a clear benefit.
