269P Achieving Treatment Goals in Elderly Breast Cancer Patients with Neoadjuvant Chemotherapy: A Remarkable Insight

Neoadjuvant chemotherapy (NAC) is widely used for locally advanced breast cancer, including HER2-positive and triple-negative subtypes. However, the impact of age on treatment response remains uncertain. This study aims to investigate treatment outcomes in elderly breast cancer patients receiving neoadjuvant chemotherapy. A retrospective analysis was conducted on breast cancer patients who underwent neoadjuvant treatment at two tertiary centers between 2010 and 2021. Patients were divided into two groups based on age: ≥65 years and <65 years. Pathologic response and surgical outcomes were compared between the groups. A total of 535 patients were included in the study, with 12% aged ≥65 years. There were no statistically significant differences in the clinicopathological characteristics between older and younger patients. The overall rate of receiving anthracycline-based chemotherapy (CT) in the entire population was 97.6%, with ddAC used more in the younger patients (71.7% vs 38.5%, p<0.001). Breast-conserving surgery and sentinel lymph node dissection were comparable between the groups. In older patients, the rate of breast downstaging was 73.5% and the rate of axillary downstaging was 70.6%, with no statistically significant difference compared to younger patients. A comparison of the groups in terms of pathological complete response revealed rates of 26.6% in younger patients and 33.3% in older patients (p>0.05). The rate of grade 3-4 toxicity was statistically higher in elderly patients (71% vs. 46.4%, p<0.01). No treatment-related deaths were observed. The median follow-up period was 50 months. Recurrence occurred in only 84 (17%) patients, with a recurrence rate of 10.4% in elderly patients compared to 17% in the other group (p=0.17). The study suggests that elderly patients achieve similar outcomes to younger patients, indicating that age alone should not be a basis for undertreatment. Further research focusing on personalized approaches for the geriatric population is needed.