QOL vs Survival Should be Considered Prior to Chemo in Geriatric TNBC

It is important to consult with geriatric patients with triple-negative breast cancer (TNBC) on the risks and benefits of chemotherapy to help them make decisions about treatment that may best preserve their quality of life, according to Ana Sandoval Leon, MD.

In a conversation with CancerNetwork^® during the 2023 San Antonio Breast Cancer Symposium (SABCS), Sandoval Leon spoke about findings from a National Cancer Database analysis assessing outcomes in elderly patients with TNBC based on whether they received chemotherapy with or without immunotherapy. According to Sandoval Leon, a breast oncologist at Miami Cancer Institute of Baptist Health, the limited number of patients 81 years or older in the database may have contributed to a lack of a significant difference in survival outcomes based on treatment course for this group.

Among patients 81 years or older, the 1-year and 3-year survival rates, respectively, were 87.1% (95% CI, 84.1%-90.1%) and 62.3% (95% CI, 56.8%-67.7%) in a group that received chemotherapy with or without immunotherapy compared with 85.0% (95% CI, 83.2%-86.9%) and 58.0% (95% CI, 54.7%-61.3%) in a group that did not receive chemotherapy. The difference in mortality between these groups did not reach statistical difference (P = .0616).

Transcript:

Our analysis was looking at systemic therapy in geriatric patients with triple-negative breast cancer. It was a National Cancer Database analysis. We know that geriatric patients are underrepresented in clinical trials, and with improved survival and increased incidence of breast cancer in the United States, we really need better guidance about the treatment of these patients. We wanted to know if there was an age cutoff over which chemotherapy was not beneficial in this patient group.

We did find an age cutoff of 81 years. We [also] adjusted for different covariates; we did Cox regression for these. It was interesting to find that there was a key in the age cutoff. The only issue that we saw was that the number of patients who were older than 81 years in the database was small. This could also be the reason why we couldn’t find a statistically significant difference [in outcomes]. If you see the graphs, there was still a trend towards improved survival in this group, but it was just not statistically significant.

It is important that although we did not find a difference [in outcomes], we still need to consult patients and continue to do that in our clinic. For every patient, but especially our older patients, we need to listen to them and see what their priorities are in life. Maybe when you’re 91 years old, living 2 more years is not as important as having 1 more year with a good quality of life. When they have to make the decision of taking chemotherapy, tell them about the potential risks and benefits and then help them make the decision if they want to do the chemotherapy or not.

Reference

Chamorro Y, Rubens M, Roy M, et al. Systemic therapy in geriatric patients with triple negative breast cancer: a National Cancer Database analysis. Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX; abstract PS13-07.