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Breast cancer

ASTER 70 suggests no clinical benefit from adjuvant chemotherapy in older patients with ER+HER2– breast cancer

Nature Reviews Clinical Oncology volume 22, page 707 (2025)Cite this article

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Patients with high-risk early-stage ER+HER2− breast cancer typically receive both adjuvant chemotherapy and hormonotherapy. However, patients aged ≥70 years have been under-represented in trials testing this approach; therefore, the benefits of chemotherapy over hormonotherapy alone in these patients are unclear, particularly considering their increased risk of severe toxicities and competing mortality risks. New data from ASTER 70, a pragmatic phase III trial involving a cohort reflective of this group in the real world, indicate no added benefit from chemotherapy.

ASTER 70 enrolled 1,089 patients ≥70 years of age with completely resected early-stage ER+HER2− breast cancer deemed to be at high risk of disease recurrence based on genomic grade index (GGI), an 8-gene prognostic classifier. These patients were randomly assigned to receive adjuvant taxane-based chemotherapy or anthracycline-based chemotherapy followed by standard hormonotherapy, or hormonotherapy alone. The primary end point was overall survival (OS).

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References

Original article

  • Brain, E. et al. Adjuvant chemotherapy and hormonotherapy versus adjuvant hormonotherapy alone for women aged 70 years and older with high-risk breast cancer based on the genomic grade index (ASTER 70s): a randomised phase 3 trial. Lancet 406, 489–500 (2025)

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  1. Nature Reviews Clinical Oncology http://www.nature.com/nrclinonc

    David Killock

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  1. David Killock
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Correspondence to David Killock.

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Killock, D. ASTER 70 suggests no clinical benefit from adjuvant chemotherapy in older patients with ER+HER2– breast cancer. Nat Rev Clin Oncol 22, 707 (2025). https://doi.org/10.1038/s41571-025-01070-6

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  • DOI: https://doi.org/10.1038/s41571-025-01070-6

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