How often is adjuvant chemotherapy administered to elderly women (>70 years) with early breast cancer ?

Background: No randomized trials on adjuvant treatment of operable breast cancer (BC) in elderly women are available. We thus carried out a retrospective study of chemotherapy administration in women ≥ 70 years. Material and methods: We reviewed tumor stage and treatment of all elderly BC patients referred from 1999 to 2003 to our institution. Major risk factors and therefore potential indication for chemotherapy were: T ≥2 cm, Grade 3, N positive and estrogen receptor (ER) negative status. Results: In total, 260 elderly consecutive patients were eligible (diagnosis of pT1-pT3, non-metastatic BC). Median age was 76 years (70 – 97). Fifty-five per cent underwent conservative surgery; 84.6% nodal dissection and 5.8% sentinel node biopsy. Adjuvant chemotherapy was proposed for 96 of 186 high risk patients. Thirteen refused, while chemotherapy was started in 83 patients: 84.4% CMF, 9.6% 3M (mitoxantrone, methotrexate, mitomycin), 6.0% anthracycline-based regimens. Chemotherapy was interrupted in 21 patients, completed in 56 with dose reduction ≥25% in 16.1% of cases. Therapy is still ongoing in five patients. Conclusions: Adjuvant chemotherapy was not proposed for 48.4% of elderly patients with high recurrence risk BC, probably due to age associated conditions (comorbidities, cognitive status, family support). Prospective studies are needed to determine tumor characteristics and geriatric conditions that should guide the choice for adjuvant chemotherapy in elderly patients and to define the role of biological parameters such as c-erbB2 overexpression.