Adjuvant Treatment of Elderly Breast Cancer Patients: Offer the Best Chances of Cure

Abstract

Background: Breast cancer remains the most common cancer in women and a leading cause of death. Elderly people have a higher incidence of breast cancer since it increases with age. Furthermore, the extended life expectancy and advances in imaging techniques have led to an increased number of cases. Guidelines concerning the management of this specific age group are rare, mainly due to underrepresentation of seniors in clinical trials. Moreover, increased frailty, comorbidities, and a poor performance status make it complex to determine the best therapeutic approach. Summary: In this review, we attempt to summarize the current literature and aim to provide specific approaches and recommendations for prompt diagnosis, treatment, and management of breast cancer in the elderly. Key Messages: The establishment of applicable protocols is imperative and efforts are being made in this direction. A careful geriatric assessment and adequate consultation should be the standard of care and patient’s preferences should always be considered.

A nomogram for predicting breast cancer specific survival in elderly patients with breast cancer: a SEER population-based analysis

“…Breast cancer is the most common malignant tumor and the main cause of death in elderly women [ 19 ]. Despite comprising a large proportion of breast cancer cases, the elderly are underrepresented in clinical trials [ 20 ], which is related to frailty in the elderly. Understanding the risk factors for BCSD in elderly patients with breast cancer could help comprehensively evaluate the status of patients and is of great importance for treatment decision-making.…”

Breast Cancer in Geriatric Patients: Current Landscape and Future Prospects

“…103 Physicians should therefore carefully assess compliance of their patients on the prescribed endocrine therapy and if poor compliance is an issue other alternative local treatments should be discussed like surgery and/or radiotherapy. 104 In another study that utilized the SEER database from 2001 to 2015, a total of 552 elderly women with stage I-III ER-positive breast cancer were evaluated; 82% being 80 years or older. All patients were treated with primary endocrine therapy, the authors concluded that adherence to endocrine therapy was not associated with statistically significant reduction in risk of death from breast cancer, but this can be explained by the fact that patients who were adherent to treatment were more likely to have larger tumors which means a significant bias in this conclusion.…”

“…108 The choice of agent should be based on the side effect profile, the patient's comorbidities, and preference status. 104 Capecitabine is an oral chemotherapy that is effective in older patients and usually better tolerated if started at a lower dose (1000 mg/m 2 twice daily). In a trial involving 73 patients ≥65 years with treatment-naïve metastatic breast cancer, capecitabine showed an overall response rate (ORR) of 37% with grade 3-4 adverse events (AEs) occurring in <10% of the patients.…”

“… 103 Physicians should therefore carefully assess compliance of their patients on the prescribed endocrine therapy and if poor compliance is an issue other alternative local treatments should be discussed like surgery and/or radiotherapy. 104 …”

“… 108 The choice of agent should be based on the side effect profile, the patient’s comorbidities, and preference status. 104 …”