Background: The growing population of elderly patients with breast cancer imposes challenges for treatment when frailty and comorbidities may coexist. Age alone should not be a cutoff for cancer treatment decisions: benefit and risk should be taken into account, considering comorbidities burden, functionality, life expectancy and patient preferences. Primary endocrine therapy (PET) represents an alternative when primary surgery or neoadjuvant chemotherapy would not be adequate treatment choices for patients with hormonal receptor positive (HR+) non-metastatic breast cancer. We aimed to evaluate the prognostic factors associated with survival among elderly patients treated with PET with or without surgery. Methods: We retrospectively reviewed electronic medical records of a cohort of patients who were 70 years of age or older and were treated with PET for operable non-metastatic breast cancer in an academic cancer center from 2009 to 2021. Study endpoints were progression-free survival (PFS), overall survival (OS), and factors associated with PFS and OS. For PFS, the events considered were disease progression in patients treated with PET alone, disease recurrence in those who underwent surgery, or death from any cause. Survival was estimated using the Kaplan-Meir method and compared with the log-rank test. Prognostic factors evaluated were age, histological type, grade, Ki67 index, stage, ECOG-performance status (ECOG-PS) and comorbidities burden, according to Charlson index. Univariate and multivariable analysis were performed using Cox regression. Results: PET was the first treatment for 197 pts aged 70 years or older. The median age was 81 years (range 70-101). Most patients had ductal (N=149; 75%) or lobular carcinomas (N=22; 11%), grade 1 (N=48; 24%) or grade 2 (N=114; 58%), and stage II (N=67; 34%) or stage III (N=94; 48%) disease. Half of the patients had an ECOG-PS 3 (n=65) or 4 (n=35); 165 pts (83%) had an Charlson index < 6. Seventy-two pts (36%) underwent surgery. Thirty pts (15%) had a disease recurrence or progression and 60 pts (30.5%) died; most deaths (n=38; 63%) were not related to breast cancer. In a multivariable analysis, pts with grade 3 disease had higher risk of recurrence/progression/death (HR 3.31, 95% CI 1.45-7.58, P=0.005), while those treated with surgery had a decreased risk (HR 0.37, 95% CI 0.21-0.65; P=0.001). Median PFS was 55.2 mo for pts treated with PET alone and 99.7 mo in those treated with ET followed by surgery. Median OS was 63 mo and 111.9 mo, respectively. Conclusion: In this cohort, deaths observed were mostly unrelated to breast cancer, suggesting that PET is an appropriate choice for selected pts. Nevertheless, patients with grade 3 disease and those who were not treated with surgery after PET had a higher risk of disease progression/recurrence or death. Prognostic factors can be useful to select candidates for PET. Citation Format: Erika Andrade Rocha, Jessica Monteiro Vasconcellos, Sofia Vidaurre Mendes, Pedro José Galvão Freire, Ana Paula Messias, Leticia Vecchi Leis, Otavio Noschang Moreira, Mauricio Baptista Pereira, Bruna Zanin Orsi, Augusto Araujo Neto, Vanessa Petry, Renata Colombo Bonadio, Laura Testa. Prognostic factors among elderly patients with operable non-metastatic breast cancer treated with primary endocrine therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-32.

Background: Management of metastatic breast cancer (mBC) in elderly patients (pts) faces some challenges since some pts are frail or have functionality impairment, with higher risk of severe adverse events from oncologic therapy. We aimed to assess the treatment patterns for elderly pts with MBC and evaluate factors associated with outcomes in this population. Methods: This retrospective study evaluated pts 70 years and older with mBC treated in a tertiary cancer center from 2009 to 2022. Charlson index (ChI) was used to measure comorbidities. Endpoints were proportion and type of first-line systemic therapy, rates of treatment discontinuation due to toxicities, overall survival (OS) and prognostic factors. The Kaplan-Meier method was used for survival analyses. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated using Cox regression. Results: 460 pts with mBC were evaluated. Median age was 78 years (IQR 70-96). Most pts (n=331; 72%) had hormone receptor-positive HER2-negative (HR+HER2-) BC, while 11% (n=50) had HER2-positive (HER2+) BC and 14% (n=64) triple-negative (TN) BC. Most pts has de novo metastatic disease (n=316; 69%); ECOG-PS 3-4 (n=313, 68%), and ChI ≤ 7 (n=354; 77%). Forty-five pts (10%) did not receive systemic therapy for metastatic BC; this proportion was higher among TNBC (34%) than other subtypes (HR+HER2-: 5%; HER2+: 6%) (P< 0.001). The proportion not receiving systemic therapy was also higher among pts with ECOG-PS 3-4 (13%, P< 0.001), older than 90 years (19%; P=0.069), and with ChI > 7 (15%; P=0.088). Among 165 pts who received first-line endocrine therapy, 2% discontinued due to toxicity. Ninety pts received first-line chemotherapy and 18% discontinued due to toxicity. Breast cancer was the main cause of death (94%) in the cohort. Factors associated with increased risk of death were HER2+BC (HR 1.48, 95% CI 1.04 – 2.09; P=0.027), TNBC (HR 1.52, 95% CI 1.05 – 2.20; P=0.025), age group 80-90 years (HR 1.30, 95% CI 1.02-1.64; P=0.028), ECOG-PS 3-4 (HR 2.34, 95% CI 1.73-3.15, P< 0.001), and not receiving systemic therapy (HR 4.48, 95% CI 2.88-6.98, P< 0.001). Median OS was 29 months for pts treated with systemic therapy, and 2.3 months for those who did not receive it (P< 0.001). Conclusions: Many factors influence the prognosis and the treatment decision for elderly pts with mBC. The rates of pts who do not receive systemic therapy are higher among TNBC, which points to the need for better tolerated therapies for this group. Citation Format: Sofia Vidaurre Mendes, Bruna Zanin Orsi, Jessica Monteiro Vasconcellos, Augusto Araujo Neto, Erika Andrade Rocha, Ana Paula Messias, Otavio Noschang Moreira, Pedro José Galvão Freire, Leticia Vecchi Leis, Mauricio Baptista Pereira, Vanessa Petry, Renata Colombo Bonadio, Laura Testa. Overview of the management and factors associated with outcomes of metastatic breast cancer among elderly patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-03-05.

Thymus neoplasms are frequently related to paraneoplastic autoimmune manifestations. Its most common associations are myasthenia gravis and pure red cell aplasia. Aplastic anemia has been increasingly documented as an initial presentation of thymoma. Nevertheless, its development after successful surgical resection of thymoma is a rare condition. We report a case of a 53-year-old man with severe aplastic anemia preceded by amegakaryocytic thrombocytopenia three years after thymectomy with no signs of disease recurrence. He underwent immunosuppressive therapy with cyclosporine 5 mg/kg/day and prednisone 2 mg/kg/day for six weeks. Considering the availability of a compatible donor, allogeneic stem cell transplantation was carried out. However, the patient died 11 days after transplant. A literature review was conducted, and another ten cases of aplastic anemia, diagnosed three months to four years after thymectomy, were identified. These cases suggest persistence of peripheral self-reactive T lymphocytes even years after tumor definitive treatment.