TITLE:
Increased Mortality Risk among Early Stage Hormone Receptor Positive Breast Cancer Patients Who Did Not Receive Adjuvant or Neoadjuvant Therapy
AUTHORS:
Sacha Satram-Hoang, Alisha Stein, Patricia Cortazar, Faiyaz Momin, Carolina Reyes
KEYWORDS:
Hormone Receptor Positive Breast Cancer, Elderly Patients, Adjuvant Therapy, Survival
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.1,
January
4,
2019
ABSTRACT: Background: Hormone receptor positive (HR+), human epidermal growth factor receptor
2 negative (HER2-) is the most common biologic subtype of breast cancer.
Although adjuvant therapy has demonstrated a survival benefit in clinical
trials, its use is poorly understood in the real-world among elderly breast
cancer patients since age is a barrier to receiving adjuvant therapy. An
examination of treatment patterns and outcomes associated with receipt of
adjuvant/neoadjuvant therapy among elderly HR + HER2-breast
cancer patients was undertaken. Methods: There were 18,470 HR + HER2-breast
cancer patients from the linked SEER-Medicare database. Patients were diagnosed
with stage I-III disease between 1/1/2007-12/31/2011, ≥66 years, enrolled in
Medicare Parts A, B and D, and underwent breast cancer surgery after diagnosis.
Time-varying Cox proportional hazards regression assessed overall survival. Results: There were 13,670 (74%)
patients treated with adjuvant/neoadjuvant therapy and 4800 (26%) untreated.
Compared to treated patients, untreated patients were older, had earlier stage,
lower grade, smaller tumors, poorer performance, higher comorbidity score, and
less use of a 21-gene recurrence score (RS) assay (p n RS assay was associated with lower risks. The Cox model showed a 48%
higher risk of death in untreated compared to treated patients. In a subset of
8967 patients with stage I disease, tumor size Conclusions: Older patients with
favorable clinical characteristics (earlier stage, smaller tumor, lower grade)
are less likely to be treated and have a higher risk of death compared to
adjuvant/neoadjuvant treated patients. An unmet need among older breast cancer
patients persists.