Abstract
Abstract Background: Adjuvant chemotherapy is not generally recommended for women 75 years and over due to presence of comorbid conditions and lower stage. Methods: We conducted a prospective cohort study of all women presenting with primary breast cancer (BC), aged 21-94, biopsy confirmed Stage 0-IV from 1990-2008 identified and tracked by our registry (n=8295). Clinical presentation characteristics including age, race, TNM stage, histologic type, surgical procedure, radiation and chemotherapy treatment were chart abstracted at diagnosis and follow up. Forward conditional stepwise regression was used to test for association significance for chemotherapy and the Kaplan-Meier method for disease free survival rate comparisons (DFS). Results: Women aged 75+ represented 12% of patients in our community based cancer center registry database (n=962). No change in percentage of patients aged 75+ was seen over time. The majority of 75+ BC patients were stage 0-1 (63%) with 36% stage II-III (n=339). Initial patient treatment was 74% lumpectomy/radiation (n=708), 11% mastectomy/radiation, and 11 % mastectomy/no radiation. 82% were estrogen receptor positive and of these 76% were recommended treatment with hormone therapy. 70% of patients received an oncology consult and 8% (n=76) were recommended for chemotherapy. Of the 76 patients, 59 (78%) completed chemotherapy with incompletions due to complications of therapy (10), patient choice (4), unknown (1), other reason (1), and death (1). The most commonly given chemotherapy regimens were CMF (n=21), AC/Taxol (n=13), and AC (n=7) with 13 receiving an adriamycin containing regimen and 22 receiving non-standard therapy. In a conditional logistic regression model of TNM stage I-IV 75+ patients (n=847) with outcome=adjuvant chemotherapy, significant variables by order of entry into the model were 1) TNM stage, 2) Her2/neu status, 3) estrogen receptor status and 4) age at diagnosis. Chemotherapy treatment rates for 50-59 year olds were 51%, 60-64 = 40%, 65-69 = 28%, 70-74 = 19%, and 75+ = 8% (Pearson chi square = 687.78, p<.001). DFS was equivalent for 75+ stage 0-I BC patients compared to 50-74 year olds, with a lower DFS rate among 75+ stage II-III patients (stage II: log rank test=10.21, p=.001, stage III: log rank test=4.14, p=.042). Conclusions: TNM stage was the predominant factor in deciding to treat patients 75+ with adjuvant chemotherapy. Stage 0-I patients age 75+ and 50-74 had equivalent survival. Stage II-III age 75+ patients had significantly worse DFS than age 50-74 patients. There is an urgent need to identify effective and tolerable treatment regimens for stage II-II BC patients 75 years and older. Figures available in online version. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-14.
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