Feasibility and outcome of chemotherapy in very elderly patients with metastatic breast cancer

Abstract

Background: In the Netherlands, circa 1300 women aged 375 years die every year of metastatic breast cancer (MBC). Unfortunately, in these patients data on palliative chemotherapy (CT) are lacking and prospective studies appeared cumbersome. Therefore, we retrospectively analyzed feasibility and outcome of CT in elderly MBC patients at our institutes. Methods: The files of all MBC patients aged >75 years who received first-line palliative CT between 2000 and 2015 at two Dutch teaching hospitals were reviewed. We registered patient and tumor characteristics and data on previous adjuvant and palliative treatment, comorbidity, toxicity and the reason for stopping CT. Patients with progressive disease (PD) or death within 30 days after starting CT were excluded from analysis. Results: 54 patients with a median age at diagnosis of MBC of 77.6 years (range 75-90), were treated with first-line CT. 20 patients were aged >80 years. Comorbidity was present in 38 patients. Tumor characteristics were: hormone receptor (HR) + /HER2- n = 33, HR-/HER2+ n = 9, triple positive n = 2, triple negative n = 9 and 1 was unknown. In 14 patients MBC was present at time of primary diagnosis. Prior treatment consisted of adjuvant endocrine treatment (17/35 HR+ patients), adjuvant CT (n = 7) and palliative hormonal treatment (29/35 HR+ patients). Most patients (n = 42) received single agent CT, consisting of capecitabine (n = 15), adriamycine (n = 10), paclitaxel (n = 8), vinorelbine (n = 4) or 5-fluorouracil (n = 3). Combination CT was given to 11 patients. A total of 28 patients (52%) had clinical benefit (defined as >6 months progression-free survival(PFS)). Median PFS and median overall survival (OS), analyzed according to Kaplan-Meier, from start of palliative CT were 6.8 months (95% Confidence Interval (CI) 4.8 - 8.8) and 14.4 months (95% CI 10.3 - 18.6), respectively. PFS and OS did not differ significantly between single agent or combination CT (p > .05). CT was stopped because of PD or toxicity in 32 and 13 patients (62% and 25%), respectively. Conclusions: Even in very elderly MBC patients, palliative chemotherapy may have clinical benefit in selected patients aged 75+. Single agent CT seems feasible and effective, but 25% of patients discontinued CT due to toxicity.