Elderly Women Benefit from Adjuvant Chemotherapy in Node-Positive Breast Cancer
According to results compiled from several clinical trials that were recently published in the Journal of the American Medical Association, elderly women with early-stage breast cancer achieve similar benefit from adjuvant chemotherapy as their younger counterparts.
Early-stage breast cancer refers to cancer that has not spread to distant sites in the body. Node-positive breast cancer refers to cancer that has only spread to axillary (under the arm) lymph nodes and may still be considered early-stage breast cancer. Younger patients (under age 65) with node-positive breast cancer are often offered chemotherapy following the surgical removal of their cancer, referred to as adjuvant chemotherapy. Adjuvant chemotherapy kills cancer cells that may remain in the body following surgery and reduces the risk of a cancer recurrence. However, the addition of adjuvant chemotherapy to the treatment regimen of elderly patients with node-positive breast cancer is not as routinely practiced as with that of younger patients. Many elderly patients may have existing medical conditions that do not allow them to tolerate chemotherapy; however, it is thought that elderly patients are often not offered adjuvant chemotherapy due, in part, to the perceived notion that they are not able to tolerate chemotherapy as well as younger patients and may not derive the same long-term benefits from chemotherapy. Although some research has indicated that adjuvant chemotherapy may not provide survival benefit in hormone-positive breast cancer patients over the age of 65, the overall consensus of the role of adjuvant chemotherapy in elderly patients with breast cancer varies between practitioners. Research is ongoing to evaluate the role of adjuvant chemotherapy for elderly patients in breast cancer, particularly since over half of the cases of breast cancer are diagnosed in women over the age of 65 years.
Researchers affiliated with the Cancer and Leukemia Group B (CALGB) recently analyzed data from 4 large clinical trials that evaluated different adjuvant chemotherapy treatment regimens in patients with early breast cancer. The trials included nearly 6,500 women and 542 of these patients were 65 years of age or older. Overall, elderly patients derived the same benefits with adjuvant chemotherapy as their younger counterparts in terms of cancer-free and overall survival. Treatment-related mortality was 0.2% in patients 50 years and under and 1.5% in patients 65 years or older. More intensive chemotherapy regimens and regimens containing a taxane (Taxotere® or Taxol®) were associated with improved long-term outcomes for all patients.
The researchers concluded that adjuvant chemotherapy improves cancer-free and overall survival for elderly women with node-positive breast cancer and age alone should not be a discriminatory factor in treatment including chemotherapy. It is important for elderly women to discuss their individual risks and benefits of different adjuvant chemotherapy regimens with their physician.
Reference: Muss HB, Woolf S, Berry D, et al. Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. Journal of the American Medical Association. 2005;293:1073-1081.
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