Aging is associated with an increase in the incidence of breast cancer (BC) and the prevalence of comorbidities, which can complicate decisions about initiating chemotherapy. Further, older adults with multiple comorbidities are often excluded from clinical trials, adding difficulty to therapeutic decision making. As a result, there has been insufficient data to make definitive chemotherapy recommendations for the management of BC in women aged 70 years or older.

A recent retrospect cohort study utilizing data from the National Cancer Database (NCD) sought to determine whether the receipt of adjuvant chemotherapy was associated with survival benefits in patients aged 70 years or older with multiple comorbidities and with node-positive, estrogen-receptor (ER)-positive BC. 

Of the 2,445,870 patients in the NCD database, only 1,592 patients met the inclusion criteria; of these, the mean age was 77.5 years and 96.9% were female. Only about one-fifth of patients (22%) had received chemotherapy. Patients who received chemotherapy tended to be younger (age 74 versus age 78 years), had higher-grade disease (grade 3), larger primary tumors (pT3/T4), had a higher degree of nodal burden (stage pN3), and were more likely to receive radiation therapy (67.4% vs. 43.5%) and endocrine therapy (88.3% vs. 82.5%). These differences were all statistically significant. 

In the nonmatched group, the median follow-up was 41.4 months. Median OS for the entire group was 59.5 months and ranged from 78.9 months for those who underwent chemotherapy versus 54.9 months for those who did not, a difference that was statistically significant.

In the matched group, the median follow-up was 43.1 months. The median OS in the group that received chemotherapy was 78.9 months compared to 62.7 months in the group that did not receive treatment but, this difference was not statistically significant. The standardized difference between the groups for all variables was <10.25%, indicating a well-matched cohort. 

While the study has limitations, such as lack of BC-specific survival data; difficulties using the Charlson/Deyo comorbidity score to reflect true health status; and lack of estrogen receptor and progesterone receptor percentage,  Ki67 scores and luminal subtypes data, the authors concluded that adjuvant chemotherapy may be associated with improved OS in older adults with BC. 

While not definitive, this paper adds to the data on the management of BC in older adults. It is important for pharmacists to be aware of this emerging information in order to provide the highest level of pharmaceutical care. 

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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