Evaluating clinical response to primary endocrine therapy in elderly breast cancer patients in routine practice

Endocrine therapy (ET) can be used as a definitive treatment in frail and elderly breast cancer patients who are unwilling or deemed unfit to undergo surgical treatment. This study evaluated the clinical response to ET as primary treatment in elderly patients with non-metastatic, oestrogen receptor (ER) positive breast cancer, by evaluating its effectiveness over time.

Elderly patients (≥ 70 years) with ER-positive breast cancer who had been treated with ET as primary treatment between 2008 and 2015 in two Dutch hospitals were identified through the Netherlands Cancer Registry. The primary outcome was the objectively measured clinical response at various time intervals after initiation of ET.

Out of 122 patients (median age, 86 years), 100 (82%) received ET as definitive treatment, whereas 22 (18%) received ET as neo-adjuvant endocrine therapy. Over the 3-year observation period, 25% of patients had died and 29% underwent invasive local treatment. The overall response rate after 3 years was 14% for all 122 patients and 30% for the 56 patients who were still alive and had not undergone local treatment after 3 years.

The observed clinical response to ET in a consistent proportion of patients over time suggests it may be a viable option for a selection of frail and elderly breast cancer patients with limited life expectancy.