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Top Line: The treatment of early stage breast cancer has seen fascinating trends in escalation of endocrine therapy, both in terms of duration and the addition of ovarian suppression, at the same time we’ve done all in our power to identify populations who can avoid traditional chemotherapy.
The Study: This prospective quality of life study performed on enrollees of the CANTO trial asks the bold question: is chemo really that much worse than endocrine therapy? The primary endpoint of this report was the sum score of the patient-reported EORTC Quality of Life Core 30 questionnaire at two years after initiation of either endocrine or chemotherapy. This means they were interested in capturing the overall (i.e. “sum”) impact on quality of life across 30 domains outside the short-term active therapy window in the months surrounding surgery and/or radiation. Among the almost 4300 women with data for analysis, 82% received endocrine therapy and 63% chemo. While both therapies persistently impacted at least a few domains at two years, the lasting impact of endocrine therapy was much more marked. In fact, looking at the sum score, chemo appeared to lose any negative overall effect on quality of life whatsoever—not so with endocrine therapy. Finally, while still not statistically significant, pre-menopausal women saw a greater detriment in quality of life following chemo than their post-menopausal peers, perhaps due to earlier loss of ovarian function. Vice versa was true for endocrine therapy, perhaps due to the different agents being used (i.e., aromatase inhibition is largely recognized to have a more poorly tolerated side effect profile than tamoxifen).
TBL: “Deescalating” from chemo to endocrine therapy for early stage hormone receptor(+) breast cancer may be a misnomer. | Ferreira, Ann Oncol 2019