Adjuvant chemotherapy in elderly patients with primary breast cancer: are women greater than or equal to 65 undertreated?

• Published in: Journal of cancer research and clinical oncology Vol. 142; no. 8; pp. 1847 - 1853
• Main Authors: Wallwiener, C W, Hartkopf, AD, Grabe, E, Wallwiener, M, Taran, F-A, Fehm, T, Brucker, SY, Kraemer, B
• Format: Journal Article
• Language: English
• Published: 01.08.2016
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-016-2194-4

To establish whether women over 65 years of age with newly diagnosed with breast cancer (BC) receive adjuvant chemotherapy less frequently than younger postmenopausal women and whether comorbidity influences this potential undertreatment. In a single-site, retrospective, comparative study, postmenopausal early stage BC patients treated between 01/2001 and 12/2005 at a major German university hospital were analyzed in two age Groups A and B ( greater than or equal to 65 vs. <65 years) for initiation and completion of guideline-recommended adjuvant chemotherapy. Risk stratification was based on the 2005 St. Gallen Consensus Conference criteria. Comorbidity was parametrized using the Charlson Comorbidity Index (CCI). Analysis included 634 patients, 380 in Group A and 254 in Group B. Mean age (range) was 73 (65-94) and 61 (55-64) years, respectively. The proportion of patients from Group A given greater than or equal to 3 cycles of chemotherapy was significantly decreased as compared to Group B. 52 % of patients with CCI <3 but only 20 % with CCI greater than or equal to 3 were recommended to undergo chemotherapy (p < 0.001). Median follow-up [95 % confidence interval (CI)] was 85 (82-88) months. DFS was significantly shorter in patients aged greater than or equal to 65 years as compared to younger postmenopausal patients (HR, 0.598; 95 % CI, 0.358-0.963; p = 0.048). Despite being high-risk patients, older women with early stage BC were often not given guideline-recommended chemotherapy. Higher recurrence rates compared with younger postmenopausal women suggest that older patients are undertreated. Treatment needs to be adapted to general health and tumor biology rather than age. More trials in elderly BC patients are needed.