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Neoadjuvant Chemotherapy and Endocrine Therapy for Older Patients with Estrogen Receptor Positive Breast Cancer: Comparison of Approaches

  • Breast Oncology
  • Published:
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Abstract

Background

Benefits of a pathologic complete response (pCR) following neoadjuvant therapy are well established, yet outcomes for older women are understudied. We sought to examine the pCR and overall survival (OS) rates of women with estrogen receptor (ER) positive breast cancer across age groups.

Methods

Women diagnosed with cT1–4, N0–3, M0, ER+/HER2- breast cancer (2010–2018) who underwent neoadjuvant chemotherapy (NACT) or neoadjuvant endocrine therapy (NET) followed by surgery were selected from the National Cancer Database and categorized by age. Differences were tested, and Cox proportional hazards models were used to estimate the association of response with OS after adjustment for covariates.

Results

In the 43,009-patient cohort, 84.8% received NACT and 15.2% received NET. Of those aged ≥ 70 (N = 5623), 51.0% received NACT, and 49.0% received NET. Compared with younger women receiving NACT, older women were less likely to have a breast or nodal pCR [no pCR by age: 85.1% (≥ 70 years) vs 82.2% (50–69 years) vs 77.7% (< 50 years), p < 0.001]. Rates of pCR were similarly low for all women receiving NET [no pCR by age: 95.6% (≥ 70 years) vs 95% (50–69 years) vs 96% (< 50 years), p = 0.06]. After adjustment, pCR after NACT was not associated with OS for older patients, but better survival outcomes were noted for older patients achieving pCR after NET.

Conclusion

For women with ER+/HER2- breast cancer, pCR rates after NACT are lower in older women compared with younger women, and are equally low after NET for all women. However, pCR after NET is associated with improved OS among older women, unlike pCR after NACT.

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Acknowledgement

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

This work was in part supported by Duke Cancer Institute through NIH Grant P30CA014236 (PI: Kastan) for the Biostatistics Core. Dr. Plichta is supported by the National Institutes of Health Office of Women’s Research Building Interdisciplinary Research Careers in Women’s Health K12HD043446 (PI: Amundsen).

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA

    Krislyn N. Miller DO, MS, Sydney M. Record BA, Laura H. Rosenberger MD, MS, Maggie L. DiNome MD, Gayle DiLalla MD, E. Shelley Hwang MD, MPH & Jennifer K. Plichta MD, MS

  2. Duke Cancer Institute, Duke University, Durham, NC, USA

    Samantha M. Thomas MS, Laura H. Rosenberger MD, MS, Maggie L. DiNome MD, Gayle DiLalla MD, Jeremy M. Force DO, E. Shelley Hwang MD, MPH & Jennifer K. Plichta MD, MS

  3. Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Samantha M. Thomas MS

  4. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Jeremy M. Force DO

  5. Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA

    Jennifer K. Plichta MD, MS

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  1. Krislyn N. Miller DO, MS
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  2. Samantha M. Thomas MS
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  5. Maggie L. DiNome MD
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  8. E. Shelley Hwang MD, MPH
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  9. Jennifer K. Plichta MD, MS
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Corresponding author

Correspondence to Jennifer K. Plichta MD, MS.

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Disclosures

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. J. Plichta was the recipient of research funding by the Color Foundation (PI: Plichta). She serves on the National Comprehensive Cancer Network (NCCN) Breast Cancer Screening Committee. Dr. E.S. Hwang serves on the National Cancer Institute (NCI) Breast Cancer Steering Committee and the NCCN Breast Cancer Prevention Committee. Dr L.H. Rosenberger serves on the National Comprehensive Cancer Network (NCCN) Breast Cancer Panel. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).

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Miller, K.N., Thomas, S.M., Record, S.M. et al. Neoadjuvant Chemotherapy and Endocrine Therapy for Older Patients with Estrogen Receptor Positive Breast Cancer: Comparison of Approaches. Ann Surg Oncol 30, 6141–6150 (2023). https://doi.org/10.1245/s10434-023-13880-y

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