Adjuvant Chemotherapy Decreases Relapses, Not Survival in Elderly Womem
According to a recent article published in the Journal of Clinical Oncology, the addition of chemotherapy to hormone therapy in elderly women with hormone-positive breast cancer reduces cancer recurrences, but does not improve survival compared to hormone therapy alone.
Breast cancer is diagnosed in approximately 250,000 women annually in the United States alone. Hormone-positive breast cancer is a common type of breast cancer that is stimulated to grow by the circulating female hormones, estrogen and/or progesterone. Patients with hormone-positive breast cancer are typically treated with hormone therapy, a type of therapy that either reduces the production of estrogen in the body or reduces the ability of estrogen/progesterone to promote growth and replication of the cancer cells. One common agent used as hormone therapy is tamoxifen (Nolvadex®).
Patients with early breast cancer, or cancer that has not spread to distant sites in the body, are often treated with chemotherapy following the surgical removal of their cancer, called adjuvant chemotherapy. Adjuvant chemotherapy is used to kill any undetectable cancer cells that may be remaining in the body following surgery. Unfortunately, chemotherapy is associated with side effects and is often difficult for elderly patients to tolerate. Adjuvant chemotherapy has demonstrated an improvement in survival in patients with early breast cancer; however, its role in the treatment of the elderly remains controversial.
Researchers from France recently conducted a clinical trial in an attempt to help elucidate the role of adjuvant chemotherapy in elderly patients with breast cancer. This trial included 338 women who were 65 years or older and had hormone-positive breast cancer. Approximately 50% of the patients were 70 years of age or older and 60% of patients had cancer spread to 1-3 axillary (under the arm) lymph nodes. All patients received tamoxifen following the surgical removal of their cancer and half of the patients also received adjuvant chemotherapy consisting of epirubicin (Ellence®)-based chemotherapy. Six years following therapy, cancer recurrences occurred in 27% of patients treated with chemotherapy/tamoxifen, compared with 31% of patients treated with tamoxifen alone. Recurrences occurring near or at the site of the original cancer (local recurrences) occurred in 2.2% of patients treated with chemotherapy and 6.8% of patients treated with tamoxifen only. Overall survival was 75.4% for patients treated with chemotherapy/tamoxifen, and 75.8% for those treated with tamoxifen only. There were no episodes of heart failure reported.
The researchers concluded that the addition of epirubicin-based adjuvant chemotherapy to tamoxifen does not appear to improve survival compared to tamoxifen alone in patients over 65 years of age with hormone-positive early breast cancer. However, recurrences were reduced with the addition of chemotherapy. The authors stated that further trials in this patient population are necessary to determine if particular subgroups of patients may benefit from the addition of chemotherapy. Patients who are over the age of 65 years and have been diagnosed with hormone-positive, early breast cancer may wish to speak with their physician about their individual potential risks and benefits from specific adjuvant treatment regimens.
Reference: Fargot P, Bonneterre J, Roche H, et al. Disease-free survival advantage of weekly epirubicin plus tamoxifen versus tamoxifen alone as adjuvant treatment of operable, node-positive, elderly breast cancer patients: 6-year follow-up results of the French Adjuvant Study Group 08 Trial. Journal of Clinical Oncology. 2004;22:4622-4630.
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