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      Impact of age on indication for chemotherapy in early breast cancer patients: results from 104 German institutions from 2008 to 2017

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          Abstract

          Purpose

          Today, the decision to treat patients with chemotherapy for early breast cancer (EBC) is made based on the patient’s individual risk stratification and tumor biology. In cases with chemotherapy indication, the neoadjuvant application (NACT) is the preferred option in comparison with primary surgery and adjuvant chemotherapy (ACT). Age remains a relevant factor in the decision-making process. The aim of the present study was to illustrate the impact of age on the use of systemic therapy in clinical routine.

          Methods

          The study separately analyzed chemotherapy use among six age cohorts of EBC patients who had been treated at 104 German breast units between January 2008 and December 2017.

          Results

          In total, 124,084 patients were included, 46,279 (37.3%) of whom had received chemotherapy. For 44,765 of these cases, detailed information on treatment was available. Within this cohort, chemotherapy was administered as NACT to 14,783 patients (33.0%) and as ACT to 29,982 (67.0%) patients. Due to the higher prevalence of unfavorable tumor subtypes, younger patients had a higher rate of chemotherapy (≤ 29y: 74.2%; 30–39y: 71.3%) and a higher proportion of NACT administration ( ≤ 29y: 66.9%; 30–39y: 56.0%) in comparison with elderly patients, who had lower rates for overall chemotherapy (60–69y: 37.5%; ≥ 70y: 17.6%) and NACT (60–69y: 25.5%; ≥ 70y: 22.8%). Pathologic complete response was higher in younger than in older patients (≤ 29y: 30.4% vs. ≥ 70y: 16.7%), especially for HER2− subtypes.

          Conclusion

          The data from the nationwide German cohort reveal relevant age-dependent discrepancies concerning the use of chemotherapy for EBC.

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          Most cited references50

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          Molecular portraits of human breast tumours.

          Charles Perou, Therese Sørlie, Michael B. Eisen … (2001)
          Human breast tumours are diverse in their natural history and in their responsiveness to treatments. Variation in transcriptional programs accounts for much of the biological diversity of human cells and tumours. In each cell, signal transduction and regulatory systems transduce information from the cell's identity to its environmental status, thereby controlling the level of expression of every gene in the genome. Here we have characterized variation in gene expression patterns in a set of 65 surgical specimens of human breast tumours from 42 different individuals, using complementary DNA microarrays representing 8,102 human genes. These patterns provided a distinctive molecular portrait of each tumour. Twenty of the tumours were sampled twice, before and after a 16-week course of doxorubicin chemotherapy, and two tumours were paired with a lymph node metastasis from the same patient. Gene expression patterns in two tumour samples from the same individual were almost always more similar to each other than either was to any other sample. Sets of co-expressed genes were identified for which variation in messenger RNA levels could be related to specific features of physiological variation. The tumours could be classified into subtypes distinguished by pervasive differences in their gene expression patterns.
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            Breast cancer statistics, 2019

            Carol DeSantis, Jiemin Ma, Mia Gaudet … (2019)
            This article is the American Cancer Society's biennial update on female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Over the most recent 5-year period (2012-2016), the breast cancer incidence rate increased slightly by 0.3% per year, largely because of rising rates of local stage and hormone receptor-positive disease. In contrast, the breast cancer death rate continues to decline, dropping 40% from 1989 to 2017 and translating to 375,900 breast cancer deaths averted. Notably, the pace of the decline has slowed from an annual decrease of 1.9% during 1998 through 2011 to 1.3% during 2011 through 2017, largely driven by the trend in white women. Consequently, the black-white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades. Nevertheless, the death rate remains 40% higher in blacks (28.4 vs 20.3 deaths per 100,000) despite a lower incidence rate (126.7 vs 130.8); this disparity is magnified among black women aged <50 years, who have a death rate double that of whites. In the most recent 5-year period (2013-2017), the death rate declined in Hispanics (2.1% per year), blacks (1.5%), whites (1.0%), and Asians/Pacific Islanders (0.8%) but was stable in American Indians/Alaska Natives. However, by state, breast cancer mortality rates are no longer declining in Nebraska overall; in Colorado and Wisconsin in black women; and in Nebraska, Texas, and Virginia in white women. Breast cancer was the leading cause of cancer death in women (surpassing lung cancer) in four Southern and two Midwestern states among blacks and in Utah among whites during 2016-2017. Declines in breast cancer mortality could be accelerated by expanding access to high-quality prevention, early detection, and treatment services to all women.
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              Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011

              A Goldhirsch, W. C. Wood, A S Coates … (2011)
              The 12th St Gallen International Breast Cancer Conference (2011) Expert Panel adopted a new approach to the classification of patients for therapeutic purposes based on the recognition of intrinsic biological subtypes within the breast cancer spectrum. For practical purposes, these subtypes may be approximated using clinicopathological rather than gene expression array criteria. In general, systemic therapy recommendations follow the subtype classification. Thus, ‘Luminal A’ disease generally requires only endocrine therapy, which also forms part of the treatment of the ‘Luminal B’ subtype. Chemotherapy is considered indicated for most patients with ‘Luminal B', ‘Human Epidermal growth factor Receptor 2 (HER2) positive’, and ‘Triple negative (ductal)’ disease, with the addition of trastuzumab in ‘HER2 positive’ disease. Progress was also noted in defining better tolerated local therapies in selected cases without loss of efficacy, such as accelerated radiation therapy and the omission of axillary dissection under defined circumstances. Broad treatment recommendations are presented, recognizing that detailed treatment decisions need to consider disease extent, host factors, patient preferences, and social and economic constraints.
              Article 0 comments Cited 446 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Fabian Riedel:
                ORCID: http://orcid.org/0000-0002-9693-2667
                fabian.riedel@med.uni-heidelberg.de
                Journal
                Journal ID (nlm-ta): Arch Gynecol Obstet
                Journal ID (iso-abbrev): Arch Gynecol Obstet
                Title: Archives of Gynecology and Obstetrics
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0932-0067
                ISSN (Electronic): 1432-0711
                Publication date (Electronic): 5 January 2023
                Publication date PMC-release: 5 January 2023
                Publication date (Print): 2023
                Volume: 308
                Issue: 1
                Pages: 219-229
                Affiliations
                [1 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Department of Gynecology and Obstetrics, , Heidelberg University Hospital, ; Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
                [2 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Institute of Medical Biometry, , Heidelberg University Hospital, ; Heidelberg, Germany
                [3 ]West German Breast Center (WBC) GmbH, Düsseldorf, Germany
                [4 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, National Center for Tumor Diseases, ; Heidelberg, Germany
                [5 ]Heidelberg Breast Center at the St. Elisabeth Clinic, Heidelberg, Germany
                Author information
                http://orcid.org/0000-0002-9693-2667
                Article
                Publisher ID: 6902
                DOI: 10.1007/s00404-022-06902-9
                PMC ID: 10191903
                PubMed ID: 36604331
                SO-VID: dee13a18-9912-4c14-8674-0ecdcf61680f
                Copyright © © The Author(s) 2023
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 20 November 2022
                Date accepted : 18 December 2022
                Funding
                Funded by: Medizinische Fakultät Heidelberg der Universität Heidelberg (9149)
                Open Access :

                Open Access funding enabled and organized by Projekt DEAL.

                Categories
                Subject: Gynecologic Oncology
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2023

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: early breast cancer,pathological complete response,neoadjuvant chemotherapy,age,elderly patients
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: early breast cancer, pathological complete response, neoadjuvant chemotherapy, age, elderly patients

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