ORLANDO, Florida—Women over the age of 70 with early-stage breast cancer may not need adjuvant hormonal therapy, researchers suggested here at the American Society of Breast Surgeons Annual Meeting.
“Hormone therapy added no significant benefit in terms of overall survival, recurrence-free survival, or mortality due to breast cancer,” said Andrea Behr, MD, a breast surgery oncology fellow at Cedars Sinai Medical Center in Los Angeles
At five years, women with a mean age of 78 who did not receive hormonal therapy had a 77 percent overall survival compared with 85 percent of women who did receive hormonal therapy, and at 10 years, the overall survival in these women was 57 percent if they did not have adjuvant hormone therapy and 58 percent if they did.
In an interview at her poster presentation, she said that the story was similar when the team looked at recurrence- free survival: At five years, 93 percent of the women who did not have hormone therapy were free of recurrence compared with 95 percent of those who did; and at 10 years, the respective rates were 93 and 89 percent.
And when researchers considered breast cancer-specific survival, 95 percent of the women not taking hormones were free of disease compared with 99 percent of the women who did have hormone therapy; at 10 years, 93 percent of women in both groups had achieved breast cancer-specific survival.
“Hormone therapy may not be appropriate in all patients over 70 with early-stage, hormone receptor-positive breast cancer,” she said.
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Asked for her perspective, Stephanie Bernik, MD, Chief of Surgical Oncology at Lenox Hill Hospital in New York City, noted that there have not been many studies looking at outcomes in older women so the findings in this study are provocative.
“However, the study size is small, and the trial is not randomized. Furthermore, most women in this age group now receive aromatase inhibitors and not tamoxifen, a change that occurred in more recent years than those included in this study. The findings, therefore, need to be reviewed with caution, but certainly point to the need of a larger, randomized trial in elderly women.”
Older women being diagnosed with breast cancer may be a function of increasing life expectancy, Behr noted.
“The management of older patients presents challenges, since there is no consensus on the optimal treatment. National Comprehensive Cancer Network guidelines currently do not account for differences in age. Weighing survival gains against potential morbidities associated with local and systemic treatment is a fine balance that places this population at risk of overtreatment or undertreatment.”
The most common breast cancers that are diagnosed in older women tend to be early-stage malignancies that are estrogen receptor (ER)-positive tumors with low rates of recurrence. The current standard of care is adjuvant hormonal therapy. Behr and colleagues sought to evaluate the impact of hormonal therapy in the group of women older than age 70.
The researchers performed a review of a prospectively maintained database at a single institution among women over 70 who underwent breast-conserving therapy if they were diagnosed with invasive breast cancer. The women in the study were diagnosed and treated in the period from January 2000 through December 2011.
A total of 568 women met the inclusion criteria, and of that group 334 did not receive hormonal therapy; they were compared with 234 women who were treated with hormonal therapy. Patient and tumor characteristics including age at diagnosis, tumor size, grade, and ER and progesterone receptor, HER2, and nodal status were documented and compared between the two patient populations.
Overall, the average tumor size was 1.75 centimeters in the women who received hormone therapy compared with 1.77 centimeters for women who did not. High grade tumors were diagnosed in 24.7 percent of the women who received hormone therapy and 28.3 percent of the women who did not. Intermediate-grade breast cancer was observed in 49.8 percent of those in the hormone-therapy group and 44.3 percent of those who did not receive hormone therapy; and the respective rates for patients in the low-grade group were 25.5 and 27.4 percent.
Behr noted that a higher percentage of women who received hormone therapy—97.9 percent—were diagnosed with ER-positive tumors compared with 91.6 percent of those not on hormone therapy. About 85 percent of the women who were on hormone therapy were progesterone receptor positive compared with 79 percent of those not on hormone therapy. Only 8.1 percent of the women on hormone therapy were HER2-positive compared with 12.1 percent of the women not on hormone therapy.
Nodal status was positive in 19.2 percent of the women on hormone therapy compared with 14.3 percent of those not on hormone therapy. Thirteen patients received both chemotherapy and hormone therapy.
“With median follow-up of 65 months, there was no difference in recurrence-free survival, breast cancer-specific survival, or overall survival between the two groups,” Behr reported. “Further studies are needed to confirm this in a larger population, but prospective studies in the elderly are difficult to perform.”