Outcome after neoadjuvant chemotherapy in elderly breast cancer patients - a pooled analysis of individual patient data from eight prospectively randomized controlled trials

// Gabriel von Waldenfels 1 , Sibylle Loibl 2 , Jenny Furlanetto 2 , Anna Machleidt 1 , Bianca Lederer 2 , Carsten Denkert 3 , Claus Hanusch 4 , Sherko Kümmel 5 , Gunter von Minckwitz 2 , Andreas Schneeweiss 6 , Michael Untch 7 , Kerstin Rhiem 8 , Peter A. Fasching 9 and Jens-Uwe Blohmer 1 1 Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany 2 German Breast Group, Neu-Isenburg, Germany 3 Institute of Pathology, Charité University Hospital, Berlin, Germany 4 Rotkreuzklinikum, Munich, Germany 5 Breast Center, Kliniken Essen-Mitte, Essen, Germany 6 National Center for Tumor Diseases (NCT), Heidelberg, Germany 7 HELIOS Klinikum Berlin-Buch, Berlin, Germany 8 Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Köln, Germany 9 Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany Correspondence to: Gabriel von Waldenfels, email: gabriel.von-waldenfels@charite.de Keywords: elderly; pCR; neoadjuvant; breast; cancer survival; Gerotarget Received: July 11, 2017 Accepted: February 13, 2018 Epub: February 26, 2018 Published: March 16, 2018 ABSTRACT Introduction: Recent studies showed the high and independent impact of age (<40 years) on pathologic complete response (pCR) and prognosis for patients undergoing neoadjuvant chemotherapy (NACT). Some physicians might not consider elderly patients (>65 years) for NACT due to poor prognosis or higher toxicity. The aim of this analysis is to help selecting appropriately elderly women who would benefit from NACT. Secondly, survival parameters are investigated in several histological subgroups. Methods: From 1998 to 2010, eight prospectively randomized German Breast Group (GBG) trials of anthracycline- and taxane-based NACT were performed and analyzed in this study. Results: Compared to the overall average, elderly women had significant larger tumors and more overall lymph node involvement. Histologically, they had more G2 tumors, more estrogen-receptor positive tumors. pCR (ypT0 ypN0) was strongly associated with age. The multivariable logistic regression analysis of clinical parameters showed that young age, clinical stage T4, invasive ductal cancer and poor differentiated breast cancer are predictive for high pCR. The multivariate analyses of molecular subgroups showed that age >65years is a predictor of significant lower pCR in HER2 − breast cancers. Nonetheless, HER2+ patients showed pCR rates as high − and HR+/HER2+ even higher - pCR rates compared to younger patients. Discussion: This study underlines the unfavorable impact of higher age on pCR, but it shows a realistic chance for pCR if NACT is applied - especially for HER2+ patients. Furthermore, elderly patients with non-TNBC showed a good prognosis (comparable to younger patients) regarding overall survival, even if they do not have pCR.