Treatment Strategies for Triple-Negative Primary Breast Cancer in Older Women: A Systematic Review.

PurposeAlthough the relative proportion of triple-negative breast cancer (TNBC) decreases with age, its prevalence is rising with an ageing population. This study examines real-world treatment practices, whether age in older women with TNBC (owTNBC) affects therapy and outcomes, focusing on the potentially curable nature of early-stage TNBC.MethodsA PRISMA-compliant search using PICO criteria identified literature from 2014 to 2023 across five databases (MEDLINE, Embase, PubMed, Web of Science, and Scopus), focusing on women aged 65 and older with early-stage TNBC.ResultsFrom 7,171 records, 37 studies were included. owTNBC exhibited less aggressive features, including lower Ki67, higher androgen receptor and higher Bcl2 expressions. Breast-conserving surgery with radiation therapy (RT) was associated with improved overall survival and breast cancer-specific survival (BCSS) with fewer recurrences compared with mastectomy+/-RT. Patients with owTNBC were more likely to receive RT than systemic therapy, and the lack of RT correlated with worse outcomes. Multivariate analyses showed that systemic treatment improved 5-year overall survival and BCSS. Overall outcomes did not show significant differences between women aged ≥70 and <70 at a median follow-up of 46 months.ConclusionsThe lack of overall outcome improvements following owTNBC treatments may not solely be due to absent targetable receptors, as the intrinsic biology in older patients may be relatively favourable. Instead, treatment selection biases against active treatment due to age-related factors may contribute significantly. Treatment decisions should be biology-based and guided by a multidisciplinary, holistic and patient-centred approach that carefully considers comorbidities, functional status, social support and patient preferences.