Abstract P5-16-22: Survival after adjuvant and neoadjuvant chemotherapy in elderly patients with triple negative breast cancer: A Cleveland Clinic experience

Abstract

Abstract Background: Triple negative breast cancer (TNBC) comprises of approximately 15% of the total breast cancers. There is limited data on treatment outcome of these patients in elderly population. We report our experience with elderly patients with TNBC treated at our tertiary care centers. Objectives and rationale: 1. Percentage of TNBC patients who received neoadjuvant chemotherapy (NACT) vs. Adjuvant chemotherapy (ACT). 2. Chemotherapeutic agents used for NACT and ACT. 3. Progression free survival (PFS) and overall survival (OS) after neoadjuvant CT and adjuvant CT. 4. Outcomes between elderly patients 65-74 years vs. 75 years and above. Methods: With IRB approval, the Cleveland Clinic's database was used to identify TNBC patients treated between 2000 to 2013. OFS from the diagnosis of TNBC was the primary end point. Cox proportional hazard models with stepwise variable selections were used for data analysis. Results: A total of 223 patients, divided in to two groups, were prospectively followed. The age group from 65-74 years consisted of “Group A” (N=140, median 69) and 75 or older formed “Group B” (N= 83, median 80, maximum 92). Eighty eight percent had ductal carcinoma. Clinically majority had stage I (50%) and stage II (33%) disease; 17% had stage III disease and most tumors were poorly differentiated (74%, grade 3). Slightly more than half the patients had lumpectomies (55%); and in only 13% of cases (25/190) were margins positive. Patients who received neoadjuvant (NACT), aduvant chemotherapy (ACT) and radiation therapy (RT) were 65%, 53% and 38% respectively. For NACT primarily doxorubicin, cyclophosphamide and paclitaxel were used whereas for ACT it was docetaxel with cyclophosphamide. Group B had somewhat poorer performance status than younger patients (p=.05), received chemotherapy especially neoadjuvant therapy much less frequently (p<.0001). OS and PFS were significantly lower in Group B (p=0.001 and 0.007 respectively). This holds true even if one adjusts for performance status and use of chemotherapy (p=0.04 and 0.03 respectively). Conclusion: Among elderly patients with triple negative breast cancer, those above 75 years and older have poorer outcomes compared to those with age 65-74 years. However, this is a retrospective study and has limitations; prospective randomized studies are needed to confirm these findings. Citation Format: Mohapatra S, Seepana J, Haddad A, Spiro T, Daw H. Survival after adjuvant and neoadjuvant chemotherapy in elderly patients with triple negative breast cancer: A Cleveland Clinic experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-22.