Triple negative breast cancer is more aggressive than other breast cancer
subtypes and accounts for up to 20% of all breast cancers.
Despite the poorer prognosis, there are no approved targeted treatments
available and chemotherapy remains the only choice. We examined treatment
patterns and outcomes among elderly metastatic triple-negative breast cancer
(mTNBC) patients in routine clinical practice. Methods:Patients were
identified from the linked SEER-Medicare database between 1/1/2001 and 12/31/2013 and included de novo Stage IV (n = 776) and patients with distant metastasis followed an
initial diagnosis of Stage I-III
disease (n = 1851). Kaplan-Meier analyses and time-varying Cox proportional
hazards regression were used to assess overall survival (OS). Results:The mean age at
metastatic diagnosis was 77.6 years and 1259 (48%) patients received
chemotherapy. Compared to <70 year olds, ≥70 year olds had worse performance
Gonzalez-Angulo, A.M., Timms, K.M., Liu, S., et al. (2011) Incidence and Outcome of Brca Mutations in Unselected Patients with Triple Receptor-Negative Breast Cancer. Clinical Cancer Research, 17, 1082-1089.
Dent, R., Trudeau, M., Pritchard, K.I., et al. (2007) Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence. Clinical Cancer Research, 13, 4429-4434. https://doi.org/10.1158/1078-0432.CCR-06-3045
Hutchins, L.F., Unger, J.M., Crowley, J.J., et al. (1999) Underrepresentation of Patients 65 Years of Age or Older in Cancer-Treatment Trials. The New England Journal of Medicine, 341, 2061-2067.
Lewis, J.H., Kilgore, M.L., Goldman, D.P., et al. (2003) Participation of Patients 65 Years of Age or Older in Cancer Clinical Trials. Journal of Clinical Oncology, 21, 1383-1389. https://doi.org/10.1200/JCO.2003.08.010
Mandelblatt, J.S., Hadley, J., Kerner, J.F., et al. (2000) Patterns of Breast Carcinoma Treatment in Older Women: Patient Preference and Clinical and Physical Influences. Cancer, 89, 561-573.
Harlan, L.C., Abrams, J., Warren, J.L., et al. (2002) Adjuvant Therapy for Breast Cancer: Practice Patterns of Community Physicians. Journal of Clinical Oncology, 20, 1809-1817. https://doi.org/10.1200/JCO.2002.07.052
Hebert-Croteau, N., Brisson, J., Latreille, J., et al. (1999) Time Trends in Systemic Adjuvant Treatment for Node-Negative Breast Cancer. Journal of Clinical Oncology, 17, 1458-1464. https://doi.org/10.1200/JCO.19220.127.116.118
Gennari, R., Curigliano, G., Rotmensz, N., et al. (2004) Breast Carcinoma in Elderly Women: Features of Disease Presentation, Choice of Local and Systemic Treatments Compared with Younger Postmenopasual Patients. Cancer, 101, 1302-1310.
Warren, J.L., Klabunde, C.N., Schrag, D., et al. (2002) Overview of the Seer-Medicare Data: Content, Research Applications, and Generalizability to the United States Elderly Population. Medical Care, 40, IV-3-18.
Stokes, M.E., Thompson, D., Montoya, E.L., et al. (2008) Ten-Year Survival and Cost Following Breast Cancer Recurrence: Estimates from Seer-Medicare Data. Value Health, 11, 213-220. https://doi.org/10.1111/j.1524-4733.2007.00226.x
Lamont, E.B., Herndon, J.E., Weeks, J.C., et al. (2006) Measuring Disease-Free Survival and Cancer Relapse Using Medicare Claims from Calgb Breast Cancer Trial Participants (Companion to 9344). Journal of the National Cancer Institute, 98, 1335-1338. https://doi.org/10.1093/jnci/djj363
Davidoff, A.J., Tang, M., Seal, B., et al. (2010) Chemotherapy and Survival Benefit in Elderly Patients with Advanced Non-Small-Cell Lung Cancer. Journal of Clinical Oncology, 28, 2191-2197. https://doi.org/10.1200/JCO.2009.25.4052
Klabunde, C.N., Legler, J.M., Warren, J.L., et al. (2007) A Refined Comorbidity Measurement Algorithm for Claims-Based Studies of Breast, Prostate, Colorectal, and Lung Cancer Patients. Annals of Epidemiology, 17, 584-590.
Charlson, M.E., Pompei, P., Ales, K.L., et al. (1987) A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation. Journal of Chronic Diseases, 40, 373-383.
Du, X. and Goodwin, J.S. (2001) Patterns of Use of Chemotherapy for Breast Cancer in Older Women: Findings from Medicare Claims Data. Journal of Clinical Oncology, 19, 1455-1461. https://doi.org/10.1200/JCO.2001.19.5.1455
Newschaffer, C.J., Penberthy, L., Desch, C.E., et al. (1996) The Effect of Age and Comorbidity in the Treatment of Elderly Women with Nonmetastatic Breast Cancer. Archives of Internal Medicine, 156, 85-90.
Hayes, D.F., Thor, A.D., Dressler, L.G., et al. (2007) Her2 and Response to Paclitaxel in Node-Positive Breast Cancer. The New England Journal of Medicine, 357, 1496-1506. https://doi.org/10.1056/NEJMoa071167
Hugh, J., Hanson, J., Cheang, M.C., et al. (2009) Breast Cancer Subtypes and Response to Docetaxel in Node-Positive Breast Cancer: Use of an Immunohistochemical Definition in the bcirg 001 Trial. Journal of Clinical Oncology, 27, 1168-1176.
Martin, M., Rodriguez-Lescure, A., Ruiz, A., et al. (2010) Molecular Predictors of Efficacy of Adjuvant Weekly Paclitaxel in Early Breast Cancer. Breast Cancer Research and Treatment, 123, 149-157. https://doi.org/10.1007/s10549-009-0663-z
Iglesia, M.D., Vincent, B.G., Parker, J.S., et al. (2014) Prognostic b-Cell Signatures Using mrna-seq in Patients with Subtype-Specific Breast and Ovarian Cancer. Clinical Cancer Research, 20, 3818-3829.
Nanda, R., Chow, L.Q., Dees, E.C., et al. (2016) Pembrolizumab in Patients with Advanced Triple-Negative Breast Cancer: Phase ib Keynote-012 Study. Journal of Clinical Oncology, 34, 2460-2467. https://doi.org/10.1200/JCO.2015.64.8931
Garcia-Teijido, P., Cabal, M.L., Fernandez, I.P., et al. (2016) Tumor-Infiltrating Lymphocytes in Triple Negative Breast Cancer: The Future of Immune Targeting. Clinical Medicine Insights: Oncology, 10, 31-39.
Wimberly, H., Brown, J.R., Schalper, K., et al. (2015) Pd-l1 Expression Correlates with Tumor-Infiltrating Lymphocytes and Response to Neoadjuvant Chemotherapy in Breast Cancer. Cancer Immunology Research, 3, 326-332.
Dawood, S., Broglio, K., Ensor, J., et al. (2010) Survival Differences among Women with De Novo Stage IV and Relapsed Breast Cancer. Annals of Oncology, 21, 2169-2174. https://doi.org/10.1093/annonc/mdq220
Hassett, M.J., Ritzwoller, D.P., Taback, N., et al. (2014) Validating Billing/Encounter Codes as Indicators of Lung, Colorectal, Breast, and Prostate Cancer Recurrence Using 2 Large Contemporary Cohorts. Medical Care, 52, e65-e73.