Abstract P5-14-08: Adjuvant and neoadjuvant chemotherapy for elderly patients (≥70 years) with early high-risk breast cancer: A retrospective analysis of 116 patients
Authors: Servent V , Tresch E , Vuagnat P , Bonneterre J 
Published: March 2017

Abstract
Background: adjuvant or neoadjuvant chemotherapy in elderly patients (pts) is currently considered as a toxic treatment and reserved for fit women and high-risk breast cancer; few guidelines are available in this age group. The aim of this study was to evaluate the tolerability of chemotherapy in this patient population. Patients and Methods: We performed a retrospective analysis of the use of adjuvant and neo adjuvant chemotherapy in our Cancer Center in two groups of patients (≥70y-75y and &gt;75 y) with early high-risk breast cancer. Between 2009 and 2014, 116 consecutive breast cancer patients (90pts:70-75y and 26pts:75&gt;y: range70-84) received adjuvant or neoadjuvant chemotherapy; all patients had optimal surgery. The chemotherapy regimens were 3 FEC100 (epirubicine 100mg/m2 + 5-fluorouracil and cyclophosphamide 500mg/m2) + 3 docetaxel100mg/m2 or 4 TC( docetaxel 75mg/m2 + cyclophosphamide 600mg/m2). In case of HER2 positive breast cancer (IHC3+ or Sish+), the patients received trastuzumab for one year. The treatment is considered non optimal when there was a decrease in the number of courses or a dose reduction. However Docetaxel75mg/m2 after 3 FEC100 was considered acceptable as well as weekly administration. A yearly follow-up was performed after the end of the chemotherapy. The association between clinical data and age group (70-75) or (&gt;75) was analyzed with Khi-2 test or Fisher test. Results Pts &gt; 75y had more ≥ 3 co-morbidities: (38.5% vs 18.9% (p= 0.04), had more frequently triple negative breast (TN) breast cancer (53.8% vs 20% (p=0.001), inflammatory breast cancer (19.2% vs 3.3%) (p=0.014). Pts&gt;75y had less frequently RH+ breast cancer (23.1% vs 61.1% (p=0.001); there was no significant differences for N+ between the two groups. The &gt;75y pts received more frequently growth factors: 57.7% vs 35.6% (p=0.043); they had more often comprehensive geriatric assessment: 42.3% vs 11.1% (p&lt;0.001) and were more often hospitalized (38.5% vs12.2% (p=0.002). There was no differences between the two age groups for Her2 status, SBR histoprognostic grading, grade ≥3 toxicity, 1year and persistent toxicity. One patient died in the group 70y-75y because of sepsis. There was no differences between the age groups in the rate of decrease of chemotherapy dosing. There was a statistical association between co-morbidities and grade ≥3 toxicity (p=0.004), grade≥3 toxicity and hospitalization rate (p&lt;0.001), grade ≥3 toxicity and chemotherapy dosing (p&lt;0.001). Conversely no association was found between chemotherapy dosing and 1 year health status. One year Trastuzumab was well tolerated in both groups. Conclusions: Adjuvant or neo adjuvant chemotherapy for elderly high-risk breast cancer patients is feasible. The &gt;75 years old patients, those with ≥3 co morbidities are especially frail, at risk of toxicity, hospitalization, inadequate chemotherapy. These results questioned about the best tools for survey and the value of geriatric intervention along the treatment.
Citation Format: Servent V, Tresch E, Vuagnat P, Bonneterre J. Adjuvant and neoadjuvant chemotherapy for elderly patients (≥70 years) with early high-risk breast cancer: A retrospective analysis of 116 patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-14-08.