12: Neoadjuvant Chemotherapy for Breast Cancer in the Elderly: Are We Accomplishing Our Treatment Goals?

Friday, March 11, 2022

11:01 AM – 11:09 AM CST

Location: Trinity Ballroom

Abstract Presenter(s)

Austin D. Williams, MD MSEd

Breast Surgical Oncology Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Participants should be aware of the following financial/non-financial relationships:

Austin D. Williams, MD MSEd: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Introduction: Neoadjuvant chemotherapy (NAC) is increasingly used in operable breast cancer to downstage the breast and axilla. However, rates of downstaging and tolerability of NAC in women ≥70 have not been well studied. We sought to compare downstaging rates and ability to complete NAC between women 50-69 and ≥70 years old.

Methods: Consecutively treated women ≥50 years with cT1-3N0-1 breast cancer receiving NAC followed by surgery from 11/2013 to 4/2020 were studied. Eligibility for breast conserving surgery (BCS) before and after NAC was prospectively determined by the treating surgeon. Rates of downstaging from BCS-ineligible to BCS-eligible and avoidance of axillary dissection (ALND) in cN1 patients were compared between patients 50-69 and ≥70 years old. NAC regimen and rates of completion were also assessed.

Results: Overall, 665 women with cT1-3N0-1 breast cancer ≥50 years old treated with NAC were identified; 74 (11.1%) were ≥70. Patients ≥ 70 were less likely to have lobular cancers (5% vs 10%, p=0.02); other clinicopathologic features were similar between groups. Patients ≥70 were less likely to receive an anthracycline-based NAC regimen (68% vs 94%, p< 0.001) and were less likely to complete their entire NAC regimen (58% vs 78%, p< 0.001) (Table). Of 312 BCS-ineligible patients eligible for downstaging, conversion rates to BCS eligibility were high (74%) and similar between groups (72% [≥70] vs 74% [50-69], p >0.9). Women ≥70 deemed BCS-eligible post-NAC were more likely to undergo BCS than younger patients (93% vs 74%, p=0.04). On multivariable analysis, breast pCR was predictive of conversion to BCS eligibility. Of 389 cN1 patients, 162 (42%) achieved a nodal pCR and avoided ALND, which was similar between age groups (41% [≥70] vs 42% [50-69], p >0.9). Receptor status and grade, but not age, were predictive of nodal pCR.

Conclusions: While patients ≥70 received less anthracycline-based chemotherapy and were less likely to complete their NAC regimen, they experienced high rates of breast and axillary downstaging, similar to younger patients. This suggests that well-selected elderly patients can safely receive NAC with substantial clinical benefit.

Learning Objectives:

Upon completion, participant will be able to describe the differences between elderly and non-elderly breast cancer patients deemed candidates for neoadjuvant chemotherapy.
Upon completion, participant will be able to articulate higher rates of alterations to neoadjuvant breast cancer chemotherapy regimens for elderly patients when compared with non-elderly patients.
Upon completion, participant will be able to describe that well-selected elderly patients can safely receive neoadjuvant breast cancer chemotherapy with substantial clinical benefit.