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Older women with triple-negative breast cancer (TNBC) who received chemotherapy had significantly improved survival compared with those who were recommended to undergo chemotherapy but did not receive it.

With a median follow-up of 38.3 months, the 5-year estimated overall survival rate was 68.5% for patients receiving chemotherapy compared with 61.1% for those who were recommended but did not receive chemotherapy (P<0.0001), reported Jennifer A. Crozier, MD, of Baptist MD Anderson Cancer Center in Jacksonville, Florida, and colleagues .

Women who were not recommended or given chemotherapy had a 5-year estimated overall survival rate of 53.7%.

This propensity-matched analysis used data from 16,062 women ages 70 and older with surgically treated TNBC diagnosed from 2004 to 2014 from the National Cancer Database. The investigators compared outcomes for women who were recommended chemotherapy but did not receive it (n=2,659), those who did receive it (n=7,485), and those for whom chemotherapy was not recommended and not given (n=5,732).

In a multivariate Cox regression analysis, they compared 1,884 matched pairs and showed that those who received chemotherapy had improved overall survival compared with those who were recommended but not given chemotherapy (hazard ratio [HR] 0.69, 95% CI 0.60-0.80, P<0.0001). This benefit was consistent for women with node-negative disease (HR 0.80, 95% CI 0.66-0.97, P=0.007), node-positive disease (HR 0.76, 95% CI 0.64-0.91, P=0.006), and those with a comorbidity score greater than 0 (HR 0.74, 95% CI 0.59-0.94, P=0.013).

According to Crozier, these data can be used to help patients and their oncologists quantify the value of chemotherapy in addition to surgery as part of a complex decision-making process in older women.

"In women aged 70 years or older with TNBC, we have historically had to extrapolate treatment decisions from studies of predominantly younger women who were included in the large prospective clinical trials," Crozier said. "Such trials in women older than 70 years of age are not likely to be performed in the U.S. any time soon. These results help inform a shared decision making conversation regarding the impact of chemotherapy to improve breast cancer survival in this population of women."

In that accompanied the study, Giuseppe Curigliano, MD, PhD, and Gabriella Pravettoni, PhD, of the European Institute of Oncology in Milan, acknowledged that these data help fill a knowledge gap surrounding treatment in older patients and suggest that "chemotherapy yields survival benefits in older women with triple-negative breast cancer."

Among the limitations of the study, Curigliano and Pravettoni mentioned a lack of information about geriatric assessment and frailty, which could potentially lead "to exclusion of patients from adjuvant treatment."

Study co-author Christopher Pezzi, MD, also of Baptist MD Anderson Cancer Center, acknowledged that their study did not look at frailty specifically, but said that a surrogate for performance status, the Charlson Deyo Comorbidity Score, was used; physicians' assessments of a patient's overall health were also reflected in the decision to recommend chemotherapy or not.

"Decision making surrounding a recommendation for chemotherapy in older patients is difficult and complex, and weighing the risks and benefits can be better accomplished with data quantifying the benefit, as we have attempted to provide through our research," Pezzi said.

Curigliano and Pravettoni also pointed out that only 17.9% of patients included in the study were treated with neoadjuvant chemotherapy, which is the current recommendation for TNBC.

Despite this, they agreed these data were useful for informing the shared decision-making process.

"Assessing patients' needs, values, cognitive dispositions, and medical information at the intersection of psychological and biological components is essential to empower patients in all cases," they wrote. "But in an older population, this approach is arguably even more important to ensure that older patients do not feel disenfranchised from the decision-making process and have greater autonomy over their medical care."

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