Older age limits the use of adjuvant chemotherapy according to all negative risk factors in early breast cancer patients.

Background: Adjuvant chemotherapy of elderly women is currently perceived as one of the priorities in breast cancer (BC) research and prospective trials are still lacking. We performed a retrospective analysis of the actual use of adjuvant cytotoxic treatment according to each negative prognostic factor at our Institution. Methods: Charts of 384 women ≥ 70 yrs with BC referred from 2000 to July 2003 were reviewed for tumor stage and treatment, and compared with an equal cohort of younger, randomly selected post-menopausal patients (pts) (control group). Results: 232 elderly pts with histologic diagnosis of early BC were eligible, mean age 75 yrs, range 70–97 (vs 61 yrs, range 50–69). Fifty-four percent of pts underwent conservative surgery (vs 68.7%); nodal dissection was performed in 85% (vs 92.2%), sentinel node biopsy in 4.7% (vs 5.9%). Tumor size was pT2-T3 in 43% of pts, grading was G3 in 26.7%, hormonal status was positive in 79%, lymphnodes were positive in 35%. Of 161 elderly pts presenting one or more risk factors (pT2-T3, N+, G3 or ER-), 50.3% (vs 6.7%) were not proposed adjuvant chemotherapy. Were considered unfit for adjuvant chemotherapy 50% of women with pT2-pT3 (vs 11.7%), 39.5% with nodal involvement (vs 4.3%), 38.7% with G3 (vs 1.4%) and 22.5% of ER- (vs 0%). Thirteen pts (16%) of those proposed for chemotherapy refused (vs 7.3%), while 19 women starting treatment (27.9%) were not able to complete the planned number of cycles (vs 13.2%). Toxicity in pts receiving CMF (and not anthracyclines) is outlined in table. Conclusions: Age or age-associated conditions strongly limited the choice for adjuvant chemotherapy in elderly BC pts according to all prognostic factors, with ER- status probably being the most impelling factor for its use. Toxicity of CMF regimen frequently imposed treatment interruption, therefore alternative regimens should be assessed in this age class.