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Top Line: It’s often tempting to modify treatment recommendations—particularly chemotherapy—based on someone’s age.
The Study: Even when performance status is great, you might talk yourself into thinking you’ll tip a patient over the edge. That sentiment is not without reason. Older people, despite making up a large proportion of the oncology population, are sorely underrepresented on clinical trials. Therefore, we’re left wondering if aggressive treatments are feasible, tolerable, and effective in older patients like they are in younger ones. The CALGB 49907 trial was designed to determine if less intensive chemo (capecitabine) were as effective as standard chemo (CMF or AC) for women 65 years or older with stage I-III breast cancer. Back in ‘09 it was determined that capecitabine was inferior, but here we have the 10-year results. At 10 years, relapse-free survival remained significantly higher (50 → 56%), as did breast-cancer specific survival (82 → 88%), among patients who received standard chemo. Effects on overall survival diminished, though, as non-breast cancer mortality events rose during the follow-up period. In receptor subsets, it was mainly the hormone-receptor negative group that sustained a long-term benefit from chemo.
TBL: When chemo is indicated for breast cancer, standard regimens are preferred in older women, particularly those with high risk tumor biology. | Muss, J Clin Oncol 2019