An update on adjuvant systemic therapy for elderly patients with early breast cancer

ABSTRACT

Introduction: Elderly women with early breast cancer require an individualized approach to risk assessment and treatment. Unfortunately, there are limited data to inform optimal adjuvant therapy decisions in this population. Cytotoxic chemotherapy, biologic treatments and endocrine agents, while important in reducing breast cancer recurrence and mortality, are associated with the potential for adverse effects that may be of particular significance to elderly patients.

Areas covered: In this review, we summarize the evidence for geriatric assessment in elderly patients with early breast cancer, outline special considerations for the use of chemotherapy and trastuzumab in older adults, and describe the age-specific risks of endocrine therapy in the adjuvant breast cancer setting.

Expert opinion: The treatment of elderly women with early breast cancer should take into account cancer risk, life expectancy, comorbidities, functional status, physiologic changes, and patient values. Formal geriatric assessment may better inform treatment recommendations for individual patients. In general, there is no strong evidence to suggest that older women benefit less from standard adjuvant therapies than do their younger counterparts. When choosing between endocrine therapies, the differential risks associated with each agent should be considered and particular attention to the fracture risk on aromatase inhibitors (AIs) is warranted. Enrolment of women over 70 years of age into breast cancer clinical trials should be encouraged to better inform treatment guidelines.

KEYWORDS:

• Breast cancer
• endocrine therapy
• chemotherapy
• risk assesment
• elderly

Article highlights

• Effective adjuvant treatments for early breast cancer should generally not be withheld on the basis of chronologic age alone.

• The CGA often provides useful information regarding patients’ suitability to receive cytotoxic chemotherapy, but it is time- and resource-intensive.

• Similar to chemotherapy, available evidence suggests that adjuvant endocrine therapy for early breast cancer is equally effective in older women (age 70+) as in their younger counterparts.

• Although older women may be at higher risk of fractures than younger women using AIs, the risk is attenuated by the use of adjuvant bisphosphonates, which are currently recommended for post-menopausal women with early breast cancer.

• Enrollment of older women into existing and future clinical trials should be strongly encouraged.

This box summarizes key points contained in the article

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript was not funded