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Radiotherapy Benefits Overall Survival in Older Patients With Early-Stage Triple Negative Breast Cancer
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Key Takeaways
- Radiotherapy significantly improves overall and breast cancer-specific survival in early-stage triple-negative breast cancer patients, especially in intermediate and high-risk groups.
- Triple-negative breast cancer lacks estrogen, progesterone, and HER2 receptors, limiting response to standard endocrine and HER2-directed therapies.
Presence of comorbidities in older patients with breast cancer complicates treatment decisions.
Radiotherapy (RT) significantly improved overall survival (OS) and breast cancer (BC)-specific survival (BCSS) in patients with early-stage triple negative breast cancer (TNBC), according to data published in Frontiers in Medicine.
Woman receiving radiotherapy | Image Credit: © Mark Kostich - stock.adobe.com
BC is the most common malignancy in women In the United States and the second leading cause of cancer-related mortality. TNBC is a subtype of BC characterized by the lack of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 (HER2) in tumor cells. The absence of these receptors results in poor or no response to standard endocrine therapies or HER2-directed treatments.
Women over the age of 70 account for 30% of all BC cases; however, only 3% of this population are included in clinical trials. Older patients often present with other comorbidities in addition to their BC diagnosis, contributing to elevated mortality rates and complicating treatment decisions. This underscores the crucial need for inclusion of older patients with BC in clinical research to improve their overall survival outcomes.
RT is a standard first-line treatment for BC, but its role in treatment of older patients remains uncertain. To better understand the potential benefit of RT as a treatment for patients over the age of 70 with T1-2N0-1M0 TNBC on OS outcomes, researchers performed an analysis of patient data from the Surveillance, Epidemiology, and End Results (SEER) database. Their evaluation included information from 3024 patients who were divided into 2 groups to assess the impact of RT on OS and BCSS: RT (N = 2,045; 67.6%) and non-RT (N = 979; 32.4%).
Patients in the RT group were generally younger (RT, ≥85 years, 8.9% vs. non-RT, ≥85 years, 21.5%) and presented with earlier staging. Most patients in this cohort underwent breast-conserving surgery (BCS; N = 1,945; 95.1%). Among these patients, a larger proportion of those who received RT also underwent chemotherapy compared with those who did not receive RT (47.6% vs. 31.5%).
To identify the benefit of RT for these patients, the researchers used statistical analyses involving chi-square tests, propensity score matching (PSM), Cox regression to identify risk factors, and a Kaplan-Meier analysis to compare OS and BCSS across different groups. They also developed a nomogram, which helped to evaluate individual patients scores and identify appropriate candidates for RT.
Patients treated with RT experienced benefits in OS (HR = 0.69; 95% CI = 0.60–0.79; P < .001) and BCSS (HR = 0.64; 95% CI = 0.51–0.80; P = 0.001), according to the data. This was observed in the intermediate-risk (OS, HR = 0.49, 95% CI = 0.34–0.71, P = 0.001; BCSS, HR = 0.40, 95% CI = 0.21–0.77, P = 0.018) and high-risk groups (OS, HR = 0.67, 95% CI = 0.55–0.81, P < .001; BCSS, HR = 0.61, 95% CI = 0.45–0.83, P = 0.007), compared with no significant benefit in the low-risk group (all P-values > .05). Additionally, patients from the BCS population saw significantly greater OS (HR = 0.68; 95% CI = 0.58–0.79; P < 0.001) and BCSS benefits (HR = 0.65; 95% CI = 0.51–0.84; P = 0.005) when treated with RT.
This study highlights the critical role of radiotherapy in improving survival outcomes for older patients with early-stage TNBC and reinforces the need for continued efforts to include older patients in clinical trials and tailor interventions to improve their outcomes.
