Adjuvant Systemic Therapy in Older Breast Cancer Women: Can We Optimize the Level of Care?

Abstract

Defining optimal adjuvant treatment for older women with breast cancer is challenged by the lack of level-1 clinical evidence and the heterogeneity of the older population. Nevertheless, recommendations based on reviews of available evidence mainly from retrospective subgroup analyses and extrapolation of study results from younger patients, and expert opinions, may be useful to guide treatment decisions in fit patients. But how can we properly define a “fit” older patient? In clinical practice, age by itself and clinical impression generally drive treatment decision, although the appropriateness of this judgment is under-documented. Such an approach risks overtreatment or, more frequently, undertreatment. A geriatric assessment can be valuable in oncology practice to address this issue. In this review article, we will focus only on systemic treatment and will discuss “standard” adjuvant systemic treatment strategies for fit older breast cancer patients and the role of “personalized” systemic therapy in unfit patients. The concepts conveyed in this review cannot be extrapolated to locoregional therapy.

Clinicopathologic Features and Long-Term Outcomes of Elderly Breast Cancer Patients: Experiences at a Single Institution in Korea

“…Differences between OS and BCSS in older patients also suggest that patients aged 65 or older die of causes other than their breast cancer. Functional status is a crucial factor for adjuvant treatments in the elderly and several scales of geriatric assessment have been developed [12,22,23]. The clinician should use these tools in identification of vulnerable patients from healthy patients and to avoid suboptimal treatments for fit, elderly patients.…”

“…Elderly breast cancer patients are defined as breast cancer patients aged 65 and over. We have chosen 65 years or older, however there is no consensus to define elderly breast cancer, because of the extremely low incidence for women 70 years or older in our patients’ cohort (3.6%, 159/4,388) and some geriatric recommendations [11,12]. …”

Adjuvant chemotherapy and survival outcomes in older women with HR+/HER2− breast cancer: a propensity score-matched retrospective cohort study using the SEER database

“…Older patients with BC have a higher risk of adverse events such as electrolyte imbalances, acute kidney injury, and cardiotoxicity and haematotoxicity than younger patients 36. Also, BC treatment in older women often relies on extrapolated evidence from younger populations 37. The above reasons lead to treatment of older patients with BC not being standardised and to few clinical trials being conducted specifically for this group, increasing their risk of recurrence.…”

The synthetic antihyperlipidemic drug potassium piperate selectively kills breast cancer cells through inhibiting G1-S-phase transition and inducing apoptosis

“…The subtypes are different in their biology, prognostic impact, treatment strategies and pattern of metastasis. Current treatment strategies for breast cancer include adjuvant therapies, such as chemotherapy and endocrine therapy, accompanied with surgical resection [ 3 – 6 ]. ER activation drives breast carcinogenesis in ER-positive breast cancer.…”