Achieving Treatment Goals in Elderly Breast Cancer Patients with Neoadjuvant Chemotherapy: A Remarkable Insight

Abstract

Abstract Background Neoadjuvant chemotherapy (NAC) is established for locally advanced breast cancer, even in early stages, especially in HER2-positive and triple-negative cases. However, the role of age in NAC responses is debated. This study explores the efficacy and outcomes of NAC in elderly breast cancer patients, compared to a younger cohort, to address the current knowledge gap. Methods In this retrospective cohort study, 535 patients who underwent at least 80% of their NAC regimen followed by curative surgery from 2010 to 2021 were analyzed. We assessed breast and axillary downstaging, pathologic complete response (pCR), and post-treatment toxicities. Data were stratified by age, with patients aged 65 and older constituting the elderly group. Statistical significance was established at P < 0.05. Results Anthracycline-based chemotherapy was prevalent (97.6%), favoring younger patients who received a dose-dense anthracycline regimen (71.7% vs. 38.5%, p < 0.001). Surgical outcomes, breast and axillary downstaging, and the pathological complete response showed no age-related differences. Grade 3–4 toxicity was higher in elderly patients (71% vs. 46.4%, p < 0.01), but no treatment-related deaths occurred. With a median 50-month follow-up, recurrence rates were 10.4% for the elderly and 17% for the other group (p = 0.17). Conclusion Elderly patients under NAC achieve comparable outcomes to younger counterparts, supporting personalized treatment. Age alone shouldn't dictate treatment decisions, emphasizing the need for comprehensive investigations for optimal geriatric patient care.