Primary Hormone Therapy in Elderly Women with Hormone-Sensitive Locoregional Breast Cancer: Endocrine Therapy Alone Is a Reasonable Alternative in Selected Patients

Quiroga-García, V.; Cirauqui-Cirauqui, Beatriz; Bugés-Sánchez, Cristina; Tomás, Miguel Ángel Luna; Castella-Fernández, E.; Mariscal-Martínez, A.; Margelí-Vila, M

doi:10.1159/000382112

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…The median time to local recurrence was assessed for the PET arm of each study to elucidate how long it may be safe to treat patients with solely PET to postpone surgery. Five [ 20 – 24 ] of the selected studies plus one additional study [ 25 ] that was only included in the qualitative analysis reported on time to local disease progression. Time to local disease progression for patients treated with solely PET ranged from 1.1 [ 22 ] to 5.8 [ 25 ] years, with four studies reporting median time to local progression of 1.7 [ 21 ], 2.1 [ 20 ], 2.5 [ 24 ], and 3.3 [ 23 ] years from the initiation of endocrine therapy.…”

Section: Resultsmentioning

confidence: 99%

Defer surgery in operable breast cancer: how long is too long?

et al. 2021

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Purpose The aim of this meta-analysis was to evaluate outcomes of surgery compared to primary endocrine therapy (PET) in patients with non-advanced, operable invasive breast cancer, and to determine if PET as initial therapy may safely postpone surgery. Methods The MEDLINE, EMBASE, PubMed, and Cochrane Library were searched from database inception to July 2020 to identify eligible studies. Inclusion criteria were experimental or observational studies with at least one arm treated with PET and a second arm treated with surgery with or without PET. Local recurrence or progression of disease was defined as either failure of non-operative management (tumor failing to decrease in size and/or continuous local or distant tumor growth) or relapse of breast tumor after tumor downsizing following PET. Effect estimates were expressed in hazard ratio and 95% confidence intervals (HR (95% CI)). Results The analysis included six studies with 1499 unique patients. The median time to local progression of disease was 2.3 years. Patients treated with PET alone without surgery had a higher risk of local recurrence and or progression [HR (95% CI): 1.76 (1.33, 2.31); I 2 = 84%; p < 0.001]. Patients treated with PET had more favorable outcomes in terms of overall survival [HR (95% CI): 1.24 (1.06, 1.46); I 2 = 70%; p = 0.008] and less favorable outcomes in breast cancer-specific survival [HR (95% CI): 1.13 (0.98, 1.31); I 2 = 41%; p = 0.10]. The risk of publication bias was assessed to be high in reporting local recurrence rates and low in reporting distant recurrence rates. Conclusion PET alone is inferior to surgery in the treatment of operable invasive breast cancer. However, it may be acceptable to postpone curative breast cancer surgery without risk of progression for 1.1 years or longer. Supplementary Information The online version contains supplementary material available at 10.1007/s12282-021-01302-4.

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Section: Resultsmentioning

confidence: 99%

Defer surgery in operable breast cancer: how long is too long?

et al. 2021

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“…Several previous observational studies have evaluated the clinical effectiveness of surgery and PET [43][44][45][46]. Still, only one systematic review has summarised the treatment effects in older female patients with breast cancer from such observational studies [47].…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Older Women with Oestrogen-Receptor-Positive Early-Stage Breast Cancer: Primary Endocrine Therapy vs. Surgery by Comorbidity and Frailty Levels

Wang,

Steinke,

Gavan

et al. 2024

Cancers

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Primary endocrine therapy (PET) offers non-surgical treatment for older women with early-stage breast cancer who are unsuitable for surgery due to frailty or comorbidity. This research assessed all-cause and breast cancer-specific mortality of PET vs. surgery in older women (≥70 years) with oestrogen-receptor-positive early-stage breast cancer by frailty and comorbidity levels. This study used UK secondary data to analyse older female patients from 2000 to 2016. Patients were censored until 31 May 2019 and grouped by the Charlson comorbidity index (CCI) and hospital frailty risk score (HFRS). Cox regression models compared all-cause and breast cancer-specific mortality between PET and surgery within each group, adjusting for patient preferences and covariates. Sensitivity analyses accounted for competing risks. There were 23,109 patients included. The hazard ratio (HR) comparing PET to surgery for overall survival decreased significantly from 2.1 (95%CI: 2.0, 2.2) to 1.2 (95%CI: 1.1, 1.5) with increasing HFRS and from 2.1 (95%CI: 2.0, 2.2) to 1.4 (95%CI 1.2, 1.7) with rising CCI. However, there was no difference in BCSM for frail older women (HR: 1.2; 0.9, 1.9). There were no differences in competing risk profiles between other causes of death and breast cancer-specific mortality with PET versus surgery, with a subdistribution hazard ratio of 1.1 (0.9, 1.4) for high-level HFRS (p = 0.261) and CCI (p = 0.093). Given limited survival gains from surgery for older patients, PET shows potential as an effective option for frail older women with early-stage breast cancer. Despite surgery outperforming PET, surgery loses its edge as frailty increases, with negligible differences in the very frail.

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“…Many observational studies have studied the effect of surgical treatment compared with primary endocrine treatment [ 22 – 24 ]. However, studying treatment effects in observational data is extremely challenging due to selection bias.…”

Section: Observational Studiesmentioning

confidence: 99%

Primary Endocrine Therapy in Older Women with Breast Cancer

et al. 2017

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Purpose of ReviewBreast cancer incidence increases with age. In recent years, primary endocrine therapy has been increasingly used as a treatment option for frail elderly women with breast cancer, although surgery is still the guideline-recommended treatment. In this review, we discuss the evidence for primary endocrine therapy versus surgical treatment in older women with early breast cancer.Recent FindingsBoth randomised controlled trials and recent observational studies showed a favourable progression-free survival but not overall survival for surgery plus adjuvant endocrine therapy versus primary endocrine therapy. Information about quality of life with either treatment strategy is so far lacking. Deciding who is fit for surgery and has sufficiently long life expectation to be at risk of disease progression can be supported by performing an individual geriatric assessment.SummaryThis review suggests that primary endocrine therapy is a reasonable alternative to primary surgery in frail older women with breast cancer. Future studies should focus on the long-term effects on quality of life and physical functioning.

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Primary Hormone Therapy in Elderly Women with Hormone-Sensitive Locoregional Breast Cancer: Endocrine Therapy Alone Is a Reasonable Alternative in Selected Patients

Cited by 3 publications

References 22 publications

Defer surgery in operable breast cancer: how long is too long?

Defer surgery in operable breast cancer: how long is too long?

Survival Outcomes in Older Women with Oestrogen-Receptor-Positive Early-Stage Breast Cancer: Primary Endocrine Therapy vs. Surgery by Comorbidity and Frailty Levels

Primary Endocrine Therapy in Older Women with Breast Cancer

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