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Neoadjuvant systemic therapy in geriatric breast cancer patients: a National Cancer Database (NCDB) analysis

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Abstract

Purpose

Neoadjuvant systemic therapy (NAST) can be an effective treatment option for patients with HER2 + or triple negative breast cancer (TNBC). However, its use in geriatric patients is largely understudied. Our aim is to investigate the effect of NAST in both septuagenarians and octogenarians with HER2 + or TNBC to better understand its role in the geriatric patient population.

Methods

We utilized the National Cancer Database (NCDB) to analyze female patients with HER2 + or TNBC between 70 and 89 years. We compared the baseline demographic and clinical characteristics of septuagenarians and octogenarians using mixed-effect modeling for continuous variables and conditional logistic regressions for categorical variables. Overall survival (OS) between several subgroups was compared based on a propensity score model. Kaplan–Meier method was used to calculate OS between the subgroups, and log-rank test was used to compare OS results.

Results

A total of 16,443 patients met inclusion/exclusion criteria, of which 92.9% had infiltrative ductal carcinoma and 73.5% were TNBC. Most patients received NAST as a first course of therapy (58.8%). Septuagenarians were more likely to receive NAST (65.9%), whereas octogenarians were more likely to receive upfront surgical resection (67.7%). Our analysis demonstrated OS benefit with NAST among patients who received surgical resection. However, in patients who received NAST, decline during therapy was associated with a significantly poorer OS outcomes in general.

Conclusion

When combined with surgical resection, NAST is an effective treatment option in both septuagenarians and octogenarians. Nonetheless, careful selection of NAST recipients in this population remains critical to optimize patient outcome.

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Data availability

The datasets analyzed during the current study are from the NCDB, a national registry. The American College of Surgeons (ACS) grants access to accredited Commission on Cancer (CoC) institutions via a standardized application process. Sharing these data with third parties is prohibited per the agreement with ACS upon granting the requested data file. Please refer to the Fellow of the American College of Surgeons (FACS) website to review the legal aspects and privacy policy related to this database.

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Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. USF Health Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA

    Lauren Brown

  2. Department of Surgical Oncology, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA

    Samer A. Naffouje

  3. Senior Adult Oncology Program, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA

    Christine Sam

  4. Comprehensive Breast Program, Moffitt Cancer Center, 12902 N. McKinley Drive, Tampa, FL, 33612, USA

    Christine Laronga & M. Catherine Lee

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  2. Samer A. Naffouje
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  4. Christine Laronga
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  5. M. Catherine Lee
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Contributions

All authors contributed to the study conception and design. LB was involved in analysis, writing, and edits. SN was involved in statistical analysis, writing, and edits. CS and CL were involved in interpretation, revision, and review. MCL was involved in review of results, editing of manuscript, and review. The first draft of the manuscript was written by LB and SN, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to M. Catherine Lee.

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Brown, L., Naffouje, S.A., Sam, C. et al. Neoadjuvant systemic therapy in geriatric breast cancer patients: a National Cancer Database (NCDB) analysis. Breast Cancer Res Treat 196, 441–451 (2022). https://doi.org/10.1007/s10549-022-06751-9

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