47P - Sequencing of chemotherapy and surgery among older triple-negative and HER2-positive breast cancer patients with comorbidities

Background

Studies have shown disparities in management of older patients with breast cancer, resulting in undertreatment. Older patients with co-morbidities pose a challenge for cancer care providers who must balance the risk of death due to toxicity from treatment versus the benefit of standard multimodality treatment. The aim of the study was to evaluate whether the sequencing of chemotherapy and surgery impact the ability to deliver both modalities of treatment.

Methods

A retrospective analysis of prospective data was evaluated between 2018 and 2022. We included patients >60 years of age with chronic comorbidities, with a clinical stage T1c-3 and N0-3, HER2-positive or triple-negative invasive breast cancer treated with chemotherapy alone, surgery alone, or both surgery and chemotherapy. Kaplan-Meier curves were plotted to compare the survival outcomes. Statistical analysis was done using SPSS v25.

Results

A total of 821 patients met the inclusion criteria, of whom 85.9% (N=705) underwent surgery as the initial treatment. Among patients who received chemotherapy first (N=116), 73.3% (N=85) were able to complete subsequent surgery. Factors associated with completion surgery after chemotherapy were younger age and clinical node-negative status. Among patients treated with surgery first, only 36.3% (N=256) received adjuvant chemotherapy. Among patients who received both modalities of treatment (N=341), women with more advanced stage tumors and those diagnosed in recent years were more likely to receive neoadjuvant chemotherapy. With a median follow-up of 19.3 months, cN0 patients who underwent both surgery and chemotherapy had significantly better overall survival compared to patients who received single modality of treatment.

Conclusions

In older, triple-negative or HER2-positive breast cancer patients with comorbidities, receipt of chemotherapy and surgery was associated with improved survival. Neoadjuvant chemotherapy group were twice as likely to receive both modalities of treatment than those undergoing surgery first. A multidisciplinary approach to evaluate geriatric patients with comorbidities is essential to deliver appropriate treatment and improve outcomes in this vulnerable population.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.