Treatment Strategies in Octogenarians with Early-Stage, High-Risk Breast Cancer
Octogenarians with early-stage breast cancer often have low-risk tumor biology. However, optimal treatment strategies for those with high-risk biology remain unclear.
We reviewed the records of women ages 80–89 years with biopsy-proven, Stage I–II invasive breast cancer who were referred for surgical evaluation from January 2001 through December 2010. High-risk was defined as human epidermal growth factor receptor-positive (HER2+), triple-negative (TN), or histologic grade 3 disease.
Among 178 patients, 40 (22%) were high-risk: 12 were grade 1–2 (10 HER2 + , 2 TN); 28 were grade 3 (7 HER2+, 6 TN, 15 estrogen receptor-positive (ER+)/HER2−). The high-risk group had larger tumors and more often had ductal histology and lymphovascular invasion than the low-risk group and was more likely to undergo mastectomy (18 vs. 5%, p = 0.02), radiotherapy (55 vs. 36%, p = 0.03), and chemotherapy (10 vs. 0%, p = 0.002). Endocrine therapy use was similar among ER+ patients in both groups. The four patients in the high-risk group given chemotherapy were HER2+ and received trastuzumab-based regimens, without any reported toxicities. At median follow-up of 67 months, 10% of the high-risk group had a recurrence (3 distant-only, 1 simultaneous locoregional and distant in a patient treated with mastectomy without radiotherapy).
Tailored locoregional and systemic therapy resulted in low incidence of failure in these octogenarians with high-risk cancers with low morbidity. Modern adjuvant therapies should be considered for elderly women with high-risk cancers in the absence of significant comorbidities.
This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The findings presented in this manuscript have not been published elsewhere.
The authors have no conflicts of interest to declare.
- 5.van de Water W, Seynaeve C, Bastiaannet E, et al. Elderly postmenopausal patients with breast cancer are at increased risk for distant recurrence: a tamoxifen exemestane adjuvant multinational study analysis. Oncologist. 2013;18(1):8–13.Google Scholar
- 10.Tinterri C, Gatzemeier W, Costa A, et al. Breast-conservative surgery with and without radiotherapy in patients aged 55–75 years with early-stage breast cancer: a prospective, randomized, multicenter trial analysis after 108 months of median follow-up. Ann Surg Oncol. 2014;21(2):408–15.CrossRefPubMedGoogle Scholar
- 15.Karavasilis V, Papadimitriou C, Gogas H, et al. Safety and Tolerability of Anthracycline-Containing Adjuvant Chemotherapy in Elderly High-Risk Breast Cancer Patients. Clin Breast Cancer. 2016;16(4):291–8 e293.Google Scholar
- 17.von Minckwitz G, Conrad B, Reimer T, et al. A randomized phase 2 study comparing EC or CMF versus nab-paclitaxel plus capecitabine as adjuvant chemotherapy for nonfrail elderly patients with moderate to high-risk early breast cancer (ICE II-GBG 52). Cancer. 2015;121(20):3639–48.CrossRefGoogle Scholar
- 18.Punglia RS, Hughes KS, Muss HB. Management of older women with early-stage breast cancer. Am Soc Clin Oncol Educ Book. 2015:48–55.Google Scholar