Do we need anthracyclines for elderly patients with TNBC?

Aims: Triple-negative breast cancer (TNBC) requires chemotherapy-based systemic treatment which is usually anthracycline-based (AB). A common side effect of AB regimes is cardiotoxicity, which is especially relevant in the elderly population. Our goal was to compare survival and toxicity between elderly patients with TNBC receiving anthracycline-based or anthracycline-free (AF) adjuvant chemotherapy.

Material and Methods: The study population comprised 221 women older than 65 years from the SUCCESS A and SUCCESS C study, who underwent primary surgery and received either anthracycline-based (3x fluorouracil-epirubicin-cyclophosphamide followed by 3x docetaxel) or anthracycline-free (6x docetaxel-cyclophosphamide) adjuvant chemotherapy according to a standardized protocol. The two groups were compared regarding clinic-pathological parameters (pT, pN, grading, histological subtype, type of surgery, adjuvant radiotherapy) using chi-square tests, regarding survival (overall survival, OS; invasive disease-free survival, iDFS; breast-cancer specific survival, BCSS; distant disease-free survival, DDFS; local recurrence-free survival, LRFS) using log-rank tests, and regarding side effects (grade 3 or 4 adverse events) using binary logistic regressions.

Results: There was no significant difference between the two groups regarding any of the clinic-pathological parameters. No significant difference was observed in OS, iDFS, BCSS, LRFS, or DDFS. However, elderly patients with the AB regimen had significantly more often grade 3 or 4 adverse events during adjuvant chemotherapy than patients with the AF regimen (OR 10.58; 95% CI 4.02-27.84; p<0.001).

Conclusion: AF adjuvant chemotherapy was associated with similar survival but less side effects in elderly patients with TNBC than AB chemotherapy and could thus be considered as an alternative treatment option in this population.

Interessenskonflikt:

Ich erkläre als alleinige/r AutorIn, dass ich während der letzten 3 Jahre keine wirtschaftlichen oder persönlichen Verbindungen im oben genannten Sinne hatte.

Publication History

Article published online:
03 May 2024