Management and outcomes after neoadjuvant treatment for locally advanced breast cancer in older versus younger women

Aim This study examined treatment and survival among women with locally advanced breast cancer (LABC) through comparative analyses of women >= 70 years and those <70 years. The primary endpoint was surgery with curative intention following neoadjuvant therapy. Secondary endpoints were 3-year disease free survival (DFS), overall survival (OS), response rates, and adherence to treatment guidelines. Methods Patients diagnosed and treated for LABC between 2010 and 2019 at Odense University Hospital, Denmark, were eligible. Surgical information was dichotomized into surgery and no surgery for patients >= 70 years and <70 years, and treatment response was extracted from scan and pathology reports. Adherence to treatment guidelines was registered for the initiated neoadjuvant treatment, and 3-year OS and DFS were estimated using Kaplan-Meier and Log-rank-test. Results Of 210 women, 57/102 (55.9%) of those >= 70 years received surgery with curative intent compared with 103/108 (95.4%) of those <70 years. The main reason for omitting surgery was the patient's request. Fewer women >= 70 years received neoadjuvant therapy according to guidelines compared with their younger counterparts (63.7% versus 98.1%, p < 0.001), but treatment response for women who underwent surgery was similar in both groups. A non-significant difference in 3-year DFS and OS was observed between the groups. Three-year DFS was 80.5% and 73.3%, whereas 3-year OS was 89.6% and 88.7% for patients >= 70 years and <70 years, respectively. Conclusion Among women with LABC, women >= 70 years were less likely to receive neoadjuvant therapy according to guidelines. Only half of the patients >= 70 years reached the goal of surgery with curative intent, with no difference in 3-year OS and DFS between age groups.