Highlights
- •Older patients with triple-negative breast cancer (TNBC) are under-represented in randomised control trials.
- •Chemotherapy improves survival for older TNBC patients with lymph node involvement.
- •Anthracyclines may improve survival for older patients with ≥4 positive lymph node TNBC.
- •Trials evaluating non-anthracycline regimens in TNBC should include age >65 years.
Abstract
Background
Triple-negative breast cancer (TNBC) is a subtype of breast cancer associated with
an aggressive clinical course. Adjuvant chemotherapy reduces the risk of recurrence
and improves survival in patients with node-positive TNBC. The benefit of anthracycline
plus taxane (ATAX) regimens compared with non-anthracycline-containing, taxane-based
regimens (TAX) in older women with node-positive TNBC is not well characterised.
Methods
Using the Surveillance, Epidemiology, and End Results–Medicare database, we identified
1106 women with node-positive TNBC diagnosed at age 66 years and older between 2010
and 2015. We compared patient clinical characteristics according to adjuvant chemotherapy
regimen (chemotherapy versus no chemotherapy and ATAX versus TAX). Logistic regression
was performed to estimate the odds ratios (OR) and 95% confidence intervals (CIs).
Kaplan–Meier survival curves were generated to estimate 3-year overall survival (OS)
and cancer-specific survival (CSS). Cox proportional hazard models were used to analyse
OS and CSS while controlling for patient and tumour characteristics.
Results
Of the 1106 patients in our cohort, 767 (69.3%) received adjuvant chemotherapy with
ATAX (364/767, 47.5%), TAX (297/767, 39%) or other regimens (106/767, 13.8%). Independent
predictors of which patients were more likely to receive ATAX versus TAX included
more extensive nodal involvement (≥4), age, marital/partner status and non-cardiac
comorbidities. There was a statistically significant improvement in 3-year CSS (81.8%
versus 71.4%) and OS (70.7% versus 51.3%) with the use of any chemotherapy in our
cohort (P < 0.01). Three-year CSS and OS for patients who received ATAX versus TAX were similar
at 82.8% versus 83.7% (P = 0.80) and 74.2% versus 72.7% (P = 0.79), respectively. There was a trend towards improved CSS and OS in patients
with four or more positive lymph nodes who received ATAX versus TAX (hazard ratio
0.66, 95% CI: 0.36–1.23, P = 0.19 and hazard ratio 0.68, 95% CI: 0.41–1.14, P = 0.14, respectively).
Conclusion
Among older women with node-positive TNBC, a majority of patients received adjuvant
chemotherapy, which was associated with an improvement in CSS and OS. When compared
with TAX chemotherapy, there was a trend towards better outcomes with ATAX for patients
with ≥4 nodes.
Keywords
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Article info
Publication history
Published online: February 27, 2023
Accepted:
February 14,
2023
Received in revised form:
February 10,
2023
Received:
October 5,
2022
Identification
Copyright
Published by Elsevier Ltd.
