Neoadjuvant chemotherapy for breast cancer in the elderly: Are we accomplishing our treatment goals? Journal Article
| Authors: | Williams, A. D.; Dang, C. T.; Sevilimedu, V.; Morrow, M.; Barrio, A. V. |
| Article Title: | Neoadjuvant chemotherapy for breast cancer in the elderly: Are we accomplishing our treatment goals? |
| Abstract: | Introduction: Rates of downstaging and tolerability to NAC in women age ≥ 70 years with operable breast cancer have not been well studied. We sought to compare downstaging rates and NAC completion between women age 50–69 years and age ≥ 70 years. Methods: Consecutively treated women age ≥ 50 years with cT1–3N0–1 breast cancer receiving NAC followed by surgery from November 2013 to April 2020 were studied. Rates of downstaging from breast-conserving surgery (BCS)-ineligible to BCS-eligible and avoidance of axillary dissection (ALND) in cN1 patients were compared between patients age 50–69 and ≥ 70 years. NAC regimens and rates of completion also were assessed. Results: Overall, 651 women, age ≥ 50 years, with 668 cT1–3N0–1 breast cancers that were treated with NAC, were identified; 75 (11.1%) were age ≥ 70 years. Patients age ≥ 70 years were less likely to have lobular cancers (5% vs. 10%, p = 0.03), receive an anthracycline-based regimen (69% vs. 93%, p < 0.001), and complete their entire prescribed regimen (57% vs. 78%, p < 0.001). Of 312 BCS-ineligible patients eligible for downstaging, conversion rates to BCS-eligibility were similar between age groups (72% [≥ 70] vs. 74% [50–69], p > 0.9). Women age ≥ 70 years who converted to BCS-eligible post-NAC were more likely to undergo BCS than younger patients (93% vs. 74%, p = 0.04). Of 390 cN1 patients, 162 (42%) achieved a nodal pCR; ALND avoidance was similar between age groups (43% [≥ 70] vs. 42% [50–69], p > 0.9). Conclusions: While patients age ≥ 70 years received less anthracycline-based NAC and were less likely to complete their prescribed regimen, they experienced high rates of breast and axillary downstaging, similar to younger patients, suggesting that well-selected elderly patients can safely receive NAC with substantial clinical benefit. © 2022, Society of Surgical Oncology. |
| Keywords: | adult; controlled study; human tissue; treatment response; aged; middle aged; cancer surgery; major clinical study; doxorubicin; fluorouracil; diarrhea; drug dose reduction; gastrointestinal hemorrhage; side effect; paclitaxel; chemotherapy, adjuvant; neoadjuvant therapy; methotrexate; cancer staging; antineoplastic agent; sentinel lymph node biopsy; breast cancer; mastectomy; tumor volume; neuropathy; dehydration; epidermal growth factor receptor 2; cancer screening; motivation; cyclophosphamide; deep vein thrombosis; herpes zoster; breast neoplasms; surgical approach; retrospective study; groups by age; docetaxel; pneumonia; lung embolism; gastrointestinal toxicity; hospitalization; body mass; mammography; minimal residual disease; adjuvant chemotherapy; cardiotoxicity; breast tumor; cancer size; therapy delay; hospital patient; mixed tumor; hospital admission; bacteremia; neoadjuvant chemotherapy; axilla; anthracycline derivative; trastuzumab; anthracycline; anthracyclines; atrial fibrillation; cytopenia; anaplastic carcinoma; goals; cardiomyopathy; pertuzumab; small cell carcinoma; cellulitis; axillary lymph node dissection; carcinoma, lobular; patient preference; urosepsis; bilateral cancer; triple negative breast cancer; breast-conserving surgery; diabetic ketoacidosis; lobular carcinoma; diverticulitis; failure to thrive; human epidermal growth factor receptor 2 positive breast cancer; charlson comorbidity index; invasive breast cancer; intention to treat analysis; humans; human; female; article; breast ductal carcinoma; chemotherapy-induced febrile neutropenia; hormone receptor-positive, her2-negative breast cancer; papillary carcinoma of the breast; apocrine carcinoma of the breast |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 29 |
| Issue: | 13 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2022-12-01 |
| Start Page: | 8002 |
| End Page: | 8011 |
| Language: | English |
| DOI: | 10.1245/s10434-022-12206-8 |
| PUBMED: | 35871672 |
| PROVIDER: | scopus |
| PMCID: | PMC10162805 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
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