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Review
. 2022 Dec;196(3):441-451.
doi: 10.1007/s10549-022-06751-9. Epub 2022 Oct 8.

Neoadjuvant systemic therapy in geriatric breast cancer patients: a National Cancer Database (NCDB) analysis

Lauren Brown  1 , Samer A Naffouje  2 , Christine Sam  3 , Christine Laronga  4 , M Catherine Lee  5
Affiliations
Review

Neoadjuvant systemic therapy in geriatric breast cancer patients: a National Cancer Database (NCDB) analysis

Lauren Brown et al. Breast Cancer Res Treat. 2022 Dec.

Abstract

Purpose: Neoadjuvant systemic therapy (NAST) can be an effective treatment option for patients with HER2 + or triple negative breast cancer (TNBC). However, its use in geriatric patients is largely understudied. Our aim is to investigate the effect of NAST in both septuagenarians and octogenarians with HER2 + or TNBC to better understand its role in the geriatric patient population.

Methods: We utilized the National Cancer Database (NCDB) to analyze female patients with HER2 + or TNBC between 70 and 89 years. We compared the baseline demographic and clinical characteristics of septuagenarians and octogenarians using mixed-effect modeling for continuous variables and conditional logistic regressions for categorical variables. Overall survival (OS) between several subgroups was compared based on a propensity score model. Kaplan-Meier method was used to calculate OS between the subgroups, and log-rank test was used to compare OS results.

Results: A total of 16,443 patients met inclusion/exclusion criteria, of which 92.9% had infiltrative ductal carcinoma and 73.5% were TNBC. Most patients received NAST as a first course of therapy (58.8%). Septuagenarians were more likely to receive NAST (65.9%), whereas octogenarians were more likely to receive upfront surgical resection (67.7%). Our analysis demonstrated OS benefit with NAST among patients who received surgical resection. However, in patients who received NAST, decline during therapy was associated with a significantly poorer OS outcomes in general.

Conclusion: When combined with surgical resection, NAST is an effective treatment option in both septuagenarians and octogenarians. Nonetheless, careful selection of NAST recipients in this population remains critical to optimize patient outcome.

Keywords: Breast cancer; Geriatric; Neoadjuvant systemic therapy; Toxicity.

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References

    1. DeSantis CE, Ma J, Gaudet MM et al (2019) Breast cancer statistics, 2019. CA Cancer J Clin 69(6):438–451. https://doi.org/10.3322/caac.21583 - DOI - PubMed
    1. He W, Goodkind D, Kowal P (2016) US census bureau, international population reports. An Aging World:2015. P95/US16–1 - DOI
    1. Giordano SH, Hortobagyi GN, Kau SWC, Theriault RL, Bondy ML (2005) Breast cancer treatment guidelines in older women. J Clin Oncol 23(4):783–791 - DOI - PubMed
    1. Rapoport BL, Demetriou GS, Moodley SD, Benn CA (2014) When and how do i use neoadjuvant chemotherapy for breast cancer? Curr Treat Options Oncol 15(1):86–98. https://doi.org/10.1007/s11864-013-0266-0 - DOI - PubMed
    1. Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067. https://doi.org/10.1056/NEJM199912303412706 - DOI - PubMed

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