Discussing Chemo Trends and End Point Selection in Older Patients With TNBC

Jesus D. Anampa, MD, MS, broke down shifting chemotherapy utilization patterns and methodological choices in clinical research for older patients with triple-negative breast cancer (TNBC) in a conversation with CancerNetwork.

Utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database spanning 2010 to 2021, Anampa highlighted a significant rise in adjuvant chemotherapy use among patients aged 70 to 79 years, while rates remained stagnant for those aged 80 and older. Additionally, he addressed a critical nuance in geriatric oncology trial design: why breast cancer-free survival, rather than traditional overall survival, serves as a more precise primary end point to isolate the therapeutic benefit of chemotherapy in a population with high competing risks of non-cancer mortality.

Anampa is an attending physician and associate professor of medicine at Montefiore Einstein Comprehensive Cancer Center.

Transcript:

The study was a large study. We collected the data from the large database in the United States, the SEER database, and we analyzed chemotherapy trends from the beginning of the study in 2010 to the end in 2021. We found, for this population of elder women, or older women, [who were aged] more than 70 years and who had triple negative breast cancer, the [rates of] chemotherapy increased from about 36% to 37% in 2010 to about 48% in 2021. It was a significant increase over time. Importantly, we divided all the interested groups: those who are 70 to 79, those who are 80 to 89, and those who are more than 90. This increase in chemotherapy was actively driven only by the group of 70 to 79-year-old women. What it suggests is that, actually, our use of chemotherapy has not changed for women who are 80 or older, but over time, we have increased the use of adjuvant chemotherapy for women who are 70 to 79 years old.

In clinical research, the end point is a very important topic because that’s how you interpret the results. Traditionally, in breast cancer, we have used overall survival. We use overall survival because that’s the metric that most of the clinical trials use. Patients finish treatment for breast cancer, and then they live 5 years, 6 years, etc. However, in other populations, the survival can be affected for non-cancer causes, such as, for instance, older women have a risk of cardiac disease, kidney disease, and pulmonary disease. If you measure overall survival in older women, you’re going to capture not only breast cancer deaths, but also deaths from other reasons. That’s why, in this population, we chose just to analyze the breast cancer death to [have] a [purer] analysis [assessing] the benefit of chemotherapy in these women.

Reference

Anampa JD, Avila J, Brodsky M, et al. Adjuvant chemotherapy outcomes in older adults with nonmetastatic triple-negative breast cancer. JAMA Netw Open. 2026;9(4):e265061. Published 2026 Apr 1. doi:10.1001/jamanetworkopen.2026.5061