Which Treatment for Breast Cancer Results in Better QoL?

TOPLINE:

In women aged ≥ 70 years with luminal A–like early breast cancer who had undergone breast-conserving surgery, radiotherapy is associated with better health-related quality-of-life (QoL) outcomes and a more favorable safety profile, with no differences in recurrence outcomes at 24 months compared with endocrine therapy, a recent study found.

METHODOLOGY:

• The best treatment approach following breast-conserving surgery in older adults with low-risk, early-stage breast cancer remains unclear. New research supports providing postoperative radiotherapy or endocrine therapy, not both, but there’s limited evidence to indicate which approach results in better health-related QoL outcomes in older patients.
• Researchers performed a phase 3 trial in which 731 patients with low-risk early-stage breast cancer who had undergone breast-conserving surgery were randomly assigned to receive either single-modality radiotherapy or endocrine therapy.
• The researchers reported findings from their interim analysis, which included 104 patients (median age, 75 years) who received radiotherapy as whole breast or partial breast irradiation in 5-15 fractions and 103 patients (median age, 74 years) who received endocrine therapy that consisted of daily oral aromatase inhibitors or tamoxifen for 5-10 years.
• The coprimary endpoints were health-related QoL at 24 months, assessed by global health status score of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, as well as ipsilateral breast tumor recurrence at 5 years.

TAKEAWAY:

• At 24 months, the adjusted mean change in global health status score from baseline was −3.40 (95% CI, −7.82 to 1.03; P = .13) in the radiotherapy group and −9.79 (95% CI, −14.45 to −5.13; P P = .045).
• No ipsilateral breast tumor recurrence, locoregional recurrence, or distant metastases occurred in either group. Contralateral breast cancer was reported in 2% of patients in the radiotherapy group and 1% in the endocrine therapy group.
• Physical functioning declined significantly in the endocrine therapy group (−6.90; P = .0006), while role functioning (ability to perform daily and leisure time activities, and/or work) declined significantly in the radiotherapy group (−4.88; P = .030), but differences between groups were not significant; both groups also experienced cognitive decline (−7.55 for endocrine vs −5.49 for radiotherapy), but the between-group difference was not statistically significant (P = .36).
• The rate of treatment-related adverse event rates was higher in the endocrine group (85% vs 65% for radiotherapy), but the rate of serious adverse events was the same in both groups (15%) and no treatment-related deaths occurred in either group. The most common grade 3-4 events in the endocrine group were joint pain, pelvic organ prolapse, hot flashes, myalgia, and bone pain.

IN PRACTICE:

“While these early findings support the potential of radiotherapy to maintain [health-related] QoL in older women with low-risk early-stage breast cancer, definitive conclusions regarding its broader clinical utility will depend on long-term disease control outcomes and the completion of patient accrual,” the authors concluded.

SOURCE:

This study, led by Icro Meattini, MD, Department of Experimental and Clinical Biomedical Sciences, University of Florence, was published online in The Lancet Oncology.

LIMITATIONS:

Because this interim analysis was based on a subset of the trial population, it provided preliminary conclusions on long-term efficacy and safety. The relatively short follow-up period limited the assessment of long-term survival outcomes. Additionally, this study focused on a well-defined population of older adults with low-risk breast cancer, limiting the generalizability of the findings to broader patient populations.

DISCLOSURES:

This study was supported by Fondazione Radioterapia Oncologica. Several authors reported receiving fees for advisory board participation or honoraria and having other ties with various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.