Abstract 3595
Background
Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ∼60% of deaths from BC occur in women aged 65 years and older. The management of elderly women with early BC requires careful evaluation of risks and benefits of available treatment options. Clinical trials for elderly patients in the adjuvant setting are lacking, and efficacy results obtained in general population cannot be directly extrapolated to elderly patients without specific evidences. Therefore, we examined factors associated with the prescription of adjuvant chemotherapy (aCT) and the impact of this treatment on overall survival (OS) in a large cohort of patients aged 65 years and older.
Methods
Patients were retrospectively identified from a large cohort of 23,134 early BC patients who underwent primary surgery in 18 academic centres between 1990 and 2014. A binary logistic regression was built to identify the factors associated with aCT administration. The impact of aCT on OS was analysed using a multivariate Cox regression model including age, histology, grade, tumour size, lymphovascular invasion (LVI), nodal status and endocrine therapy (ET) and endocrine receptors (ER). A propensity score-based matching analysis was performed.
Results
Of 6605 patients aged 65 years and older, 1493 received aCT (22.6%). Administration of aCT was predominantly associated with macroscopic lymph node involvement (LNi) and ER-negative status but common predictors, such as age < 80 years, ductal histology, tumour size ≥ 20mm, ET and tumour grade were also found as statistically significant. In a Cox model including age, histology, LVI, tumour size, LNi, ET, ER and grade, aCT was significantly associated with better OS (HR 0.71, 95% CI 0.58 to 0.86; p < 0.001). Ten-year OS estimates in case-matched patients for propensity score analysis were 76.8% (95% CI 76.6 to 77.1) in the aCT group vs. 61.5% (95% CI 61.3 to 61.7) without aCT (p < 0.0001). Interestingly, this benefit was maintained in the over-80s subgroup.
Conclusions
The factors associated with aCT use in the elderly are similar to those usually found in younger age groups. By highlighting an OS benefit, even in the “very old” subgroup, our results may help clarifying the role of aCT in elderly patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Houvenaeghel Gilles.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
1398 - Phase 1 study of liposomal formulation of eribulin (E7389-LF) in patients (pts) with advanced solid tumors: primary results of dose-escalation part
Presenter: Noboru Yamamoto
Session: Poster Display session 2
Resources:
Abstract
5818 - Polo-like Kinase 1 inhibitor onvansertib synergizes with paclitaxel in breast cancer carrying p53 mutation
Presenter: Antonio Giordano
Session: Poster Display session 2
Resources:
Abstract
5927 - Phase 1b study of heat shock protein 90 inhibitor, onalespib in combination with paclitaxel in patients with advanced, triple negative breast cancer (NCT02474173).
Presenter: Robert Wesolowski
Session: Poster Display session 2
Resources:
Abstract
1695 - Impact of pertuzumab and T-DM1 on prognosis of HER2-positive metastatic breast cancer (MBC) and factors affecting their efficacy: results from the AGMT_MBC-Registry
Presenter: Simon Peter Gampenrieder
Session: Poster Display session 2
Resources:
Abstract
1742 - Clinical profile and outcome of HER2 positive breast cancer patients with brain metastases treated with HER2 targeted therapy: Real world experience.
Presenter: Prabhat Bhargava
Session: Poster Display session 2
Resources:
Abstract
1846 - Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer: results of single arm phase IV COMACHI study
Presenter: Norikazu Masuda
Session: Poster Display session 2
Resources:
Abstract
5385 - Anti HER-2 Therapies and Left Ventricular Dysfunction The Renaissance Study
Presenter: ANDRES DANIELE
Session: Poster Display session 2
Resources:
Abstract
3320 - Safety and efficacy of T-DM1 in 128 patients with advanced HER2+ breast cancer: The Royal Marsden experience.
Presenter: Nicolò Battisti
Session: Poster Display session 2
Resources:
Abstract
4540 - Use of trastuzumab emtansine (T-DM1; K) after pertuzumab + trastuzumab (PH) in patients with HER2-positive metastatic breast cancer (mBC): challenges in assessing effectiveness of treatment sequencing in the real world (RW)
Presenter: Thibaut Sanglier
Session: Poster Display session 2
Resources:
Abstract
2376 - Patient Reported Outcomes (PRO) in patients (pts) with HER2- advanced breast cancer (ABC) and a germline BRCA1/2 mutation (gBRCAm) receiving talazoparib (TALA) vs physician’s choice chemotherapy (PCT) in the EMBRACA trial: A focus on subgroups with/ without visceral disease
Presenter: Johannes Ettl
Session: Poster Display session 2
Resources:
Abstract