Abstract P6-12-01: Adjuvant treatment in breast cancer patients aged 70 years or older during three years. A systematic review of patients charts.
Authors: Nätterdal T , Klint L , Holmberg E , Gunnarsdottír KA , Linderholm BK 
Published: August 2014

Background and aims: In general, previous studies on adjuvant chemotherapy have not included the elderly breast cancer (BC) population. Our aim was to investigate the actual recommended adjuvant therapy for patients' age ≥70 years in clinical routine. We also determined the proportion of patients that terminated therapy in correlation to documented BC relapses.

Material and Methods: Charts from consecutive patients diagnosed with a primary stage I-III BC from 1st January 2005 through 31st December 2007, age ≥70 years were studied (n = 358). Data regarding standard BC parameters at diagnosis, adherence to recommended adjuvant therapy, reasons for suspension of treatment and outcome were documented. Comparisons were performed with patients divided into three age groups (70–74; 75–79; and ≥80 years) and between different treatment modalities (i.e. endocrine therapy; chemotherapy; trastuzumab).

Results: Higher age was statistically significantly correlated with axillary metastases (70–74y n=30, [30%]; 75–79 n=41, [49%]; and ≥80y n=120 [42%], (p = 0.011), while tumor size were equal (p = 0.103). No difference was found regarding routine BC parameters as histological type (p = 0.636) or grade (p = 0.662); vascular invasion (p = 0.681); ER (p = 0.892); PgR (p = 0.718) or HER2 status (p = 0.542). A total of 286 patients were advised adjuvant systemic therapy; only two patients received trastuzumab. A higher proportion of the oldest patients ≥80 (n = 32 [22%]) were left without any treatment compared with 75–79y (n = 17 [17%] and 70–74y (n = 13 [13%], (p = 0.0002), this was explained by differences regarding chemotherapy. Data on compliance was lacking for five patients, however there was a trend not reaching statistically significance revealing a correlation between higher age and a more frequent treatment termination (p = 0.061). Treatment suspension was for chemotherapy (70–74y n=21, [52%]; 75–79 n=17, [71%]; and ≥80y n=3 [100%] and for ET (70–74y n=69, [25%]; 75–79 n=66, [32%]; and ≥80y n=104 [46%]. There was a statistically significant correlation between higher age and more breast cancer relapses (BCR) (p = 0.015) and RFS (p = 0.038). We found a higher proportion of BCR among patients terminating planned treatment (n = 112; 27% BCR) compared with patients adherent to therapy (n = 168; 8% BCR) (p = 0.015). Patients not recommended any treatment (n = 62) had an intermediate outcome with 16% BCR. This observation was found in all age groups; patients terminating therapy; 70–74y 21% BCR, 75–79y 42% BCR and ≥80y 20% BCR respectively compared with patients' adherent to therapy 70–74y 6% BCR, 75–79y 10% BCR and ≥80y 7% respectively.

Conclusions: Elderly patients are diagnosed with BC at a later stage and adjuvant chemotherapy, as well as, endocrine therapy prematurely terminated. Insufficient treatment was significantly associated with increased risk of relapse. Less toxic regimens should be carefully investigated.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-12-01.