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. 2018 Feb 26;9(20):15168-15179.
doi: 10.18632/oncotarget.24586. eCollection 2018 Mar 16.

Outcome after neoadjuvant chemotherapy in elderly breast cancer patients - a pooled analysis of individual patient data from eight prospectively randomized controlled trials

Gabriel von Waldenfels  1 , Sibylle Loibl  2 , Jenny Furlanetto  2 , Anna Machleidt  1 , Bianca Lederer  2 , Carsten Denkert  3 , Claus Hanusch  4 , Sherko Kümmel  5 , Gunter von Minckwitz  2 , Andreas Schneeweiss  6 , Michael Untch  7 , Kerstin Rhiem  8 , Peter A Fasching  9 , Jens-Uwe Blohmer  1
Affiliations

Outcome after neoadjuvant chemotherapy in elderly breast cancer patients - a pooled analysis of individual patient data from eight prospectively randomized controlled trials

Gabriel von Waldenfels et al. Oncotarget. .

Abstract

Introduction: Recent studies showed the high and independent impact of age (<40 years) on pathologic complete response (pCR) and prognosis for patients undergoing neoadjuvant chemotherapy (NACT). Some physicians might not consider elderly patients (>65 years) for NACT due to poor prognosis or higher toxicity. The aim of this analysis is to help selecting appropriately elderly women who would benefit from NACT. Secondly, survival parameters are investigated in several histological subgroups.

Methods: From 1998 to 2010, eight prospectively randomized German Breast Group (GBG) trials of anthracycline- and taxane-based NACT were performed and analyzed in this study.

Results: Compared to the overall average, elderly women had significant larger tumors and more overall lymph node involvement. Histologically, they had more G2 tumors, more estrogen-receptor positive tumors. pCR (ypT0 ypN0) was strongly associated with age. The multivariable logistic regression analysis of clinical parameters showed that young age, clinical stage T4, invasive ductal cancer and poor differentiated breast cancer are predictive for high pCR. The multivariate analyses of molecular subgroups showed that age >65years is a predictor of significant lower pCR in HER2- breast cancers. Nonetheless, HER2+ patients showed pCR rates as high- and HR+/HER2+ even higher - pCR rates compared to younger patients.

Discussion: This study underlines the unfavorable impact of higher age on pCR, but it shows a realistic chance for pCR if NACT is applied - especially for HER2+ patients. Furthermore, elderly patients with non-TNBC showed a good prognosis (comparable to younger patients) regarding overall survival, even if they do not have pCR.

Keywords: Gerotarget; breast; cancer survival; elderly; neoadjuvant; pCR.

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Conflict of interest statement

CONFLICTS OF INTEREST Claus Hanusch: Speaker/Advisory Board: Roche, Amgen, Novartis, Cellgene. Sherko Kümmel: Honoraria: Roche, Amgen, Novartis, Teva, Daiichi-Sankyo, Celgene, Pfizer; Research Funding: Roche; Travel, Accomodations, Expenses: Roche, Teva. Peter A. Fasching: Honoraria: Amgen, Novartis, Pfizer, Celgene, Roche.

Figures

Figure 1
Figure 1. Distant disease free survival by age
Log-rank p-value = 0.016.
Figure 2
Figure 2. Local-recurrence-free survival by age
Log-rank p-value = 0.001.
Figure 3
Figure 3. Disease free survival
Log-rank p-value = 0.009.
Figure 4
Figure 4. Overall survival in patients with a pathological complete response by age
Log-rank p-value = 0.899.
Figure 5
Figure 5. Overall survival in patients without a pathological complete response by age
Log-rank p-value = 0.001.
Figure 6
Figure 6. Overall survival in patients with and without a pathological complete response by age; log-rank p value = 0.001
See this image and copyright information in PMC

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