Primary endocrine therapy in elderly women with hormone sensitive breast cancer: disease response and clinical benefit outcomes


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Walid Sasi1,Petros Christopoulos1,Mihai Mancas1,Claire Murphy1
1Airedale General Hospital

Abstract

Background

Primary endocrine therapy (PET) is often offered to frail elderly patients with hormone receptor-positive breast cancer, who may also have significant co-morbidities or refuse surgery. The majority respond well to PET but some experience disease progress and require either change of their endocrine treatment or surgery. We aimed to look at all patients treated with PET at our local unit over a five-year period focusing on their disease criteria, objective response rate, and clinical benefit rate.

Method

All women treated with PET at Airedale General Hospital, who were diagnosed with Stage I-III HR+ve breast cancer between January 2010-January 2015 were identified from prospectively collected data and follow-up records, and included in this study.

Results

77 patients received PET. The median age at diagnosis is 87 years (range:67-98). 24 patients (31%) have Stage-I, 42(55%) have Stage-II, and 11(14%) have Stage-III disease. Disease grades 1, 2, and 3 were seen in 37(48%), 23(30%), and 17 patients (22%) respectively. The median PET duration is 33 months (range:2-299), and the median survival is 36 months (range:2-301). At the time of this report, 31 patients (40%) are alive, 42(56%) had died from breast cancer non-related causes, and only 3(4%) had died from complications of advancing disease. Complete PET-induced disease response was seen in 15 patients (20%), partial response in 30(39%), while static disease was observed in 22(29%), and disease progress in 10(13%). The PET-induced objective response rate is 58%, and the clinical benefit rate is 87%. Changing the endocrine agent was required in 20 patients (26%), and only 5(7%) had ultimately required surgery.

Conclusion

The majority of breast cancer patients who fulfil the selection criteria to receive primary endocrine therapy do well and will have good clinical benefit and objective response rates. PET proves to be effective means to control the disease, and an alternative option to surgery.