Hormone therapy in elderly breast cancer patients with comorbidities

Crivellari, Diana; Spazzapan, Simon; Puglisi, Fabio; Fratino, Lucia; Scalone, Simona; Veronesi, Andrea

doi:10.1016/j.critrevonc.2009.02.003

Cited by 22 publications

(12 citation statements)

References 60 publications

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“…The Arimidex Tamoxifen Alone or in Combination trial confirmed the above findings by showing that anastrozole treatment improved DFS compared to tamoxifen therapy (hazard ratio, 0.75; p =0.01) and prolonged the time to recurrence, with fewer thromboembolic events and endometrial carcinomas, even after a median follow-up of 100 months [ 91 92 ]. The median age of patients in this trial was 64 years with 27% of the cohort aged over 70, but no data were available regarding tolerance and efficacy in the elderly subgroup [ 93 ]. Besides, the superiority of AIs was recently confirmed in two separate meta-analyses.…”

Section: Therapymentioning

confidence: 99%

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

et al. 2015

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Breast cancer generally develops in older women and its incidence is continuing to increase with increasing age of the population. The pathology and biology of breast cancer seem to be different in the elderly, often resulting in the undertreatment of elderly patients and thus in higher rates of recurrence and mortal-ity. The aim of this review is to describe the differences in the biology and treatment of early breast cancer in the elderly as well as the use of geriatric assessment methods that aid decision-making. Provided there are no contraindications, the cornerstone of treatment should be surgery, as the safety and efficacy of surgical resection in elderly women have been well documented. Because most breast cancers in the elderly are hormone responsive, hormonal therapy remains the mainstay of systemic treatment in the adjuvant setting. The role of chemotherapy is limited to patients who test negative for hormone receptors and demonstrate an aggressive tumor profile. Although the prognosis of breast cancer patients has generally improved during the last few decades, there is still a demand for evidence-based optimization of therapeutic interventions in older patients.

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Section: Therapymentioning

confidence: 99%

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

et al. 2015

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“…A four-stage classification derived from the CGA has been proposedprimary, intermediate, secondary or frailty, and tertiary or near to death-together with clinical descriptions and therapeutic implications [4]. Rather than chronological age, oncologists may take into account the functional age of their patients, but they regrettably underuse CGA or comorbidity scoring [5]. The ability to complete activities of daily living (ADL) and instrumental ADL (IADL) reflects one's skill at maintaining independence at home and among the community.…”

Section: Which Definition For An Elderly Woman?mentioning

confidence: 99%

“…Comorbidities, particularly, previous cancer and diabetes, impair the 5-year survival rate [9]. Furthermore, treatments prescribed to control concomitant diseases can also enhance the risk for treatment-related complications, with a potential adverse influence on survival [5].…”

Section: Which Definition For An Elderly Woman?mentioning

confidence: 99%

Current Targeted Therapies in Breast Cancer: Clinical Applications in the Elderly Woman

Spano¹,

Falandry

Chaïbi

2011

The Oncologist

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After completing this course, the reader will be able to:1. Include geriatric assessment into oncologic practice to describe patients and to evaluate the real benefit/risk ratio of any adjuvant treatment.2. Describe the actual risk of association of erythropoiesis-stimulating agents with bevacizumab.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTThe incidence of breast cancer is two to three times higher in women aged >65 years than in the whole population, whereas their mortality rate is threefold to fourfold higher. Targeted therapies allow significantly longer disease-free survival times. Nevertheless, in an elderly population, these treatments need to be prescribed with caution. This paper reviews the treatments of breast cancer in the elderly, and the issues of targeted therapies and their toxicities. Patients with human epidermal growth factor receptor (HER)-2؉ breast cancer benefit from trastuzumab; although cardiotoxic effects are observed in <5% of pa- The Oncologist ® The Oncologist CME Program is located online at http://cme.theoncologist.com/. To take the CME activity related to this article, you must be a registered user. Geriatric OncologyThe Oncologist 2011;16:1144 -1153 www.TheOncologist.com tients when given alone, they affect ϳ25% of patients when combined with anthracyclines. Bevacizumab leads to a longer progression-free survival time and lower risk for progression in patients with metastatic breast cancer when added to paclitaxel or docetaxel. Although generally well tolerated, it is associated with a higher risk for arterial thromboembolism and hypertension. Lapatinib is approved for the treatment of advanced or metastatic breast cancer in patients not responding to trastuzumab, combined with capecitabine chemotherapy. The most frequent side effects concern the gastrointestinal system and dermatologic symptoms.The life expectancy of breast cancer patients should be taken into account to determine the appropriateness of treatments. The quality of life of elderly cancer patients must be assessed with an appropriate tool. Older patients exhibit greater vulnerability, suggesting identification and exclusion of patients at high cardiac risk.Future recommendations for the treatment of elderly women with breast cancer should include a multidisciplinary approach and a global geriatric assessment before treatment with anti-HER-2 therapy or bevacizumab.

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“…Most older BC patients receive adjuvant endocrine therapy because they are more likely to have a receptor positive disease, which tends to grow more slowly, are usually well differentiated, and respond better to endocrine therapy. However, there are side effects associated with endocrine therapy, like deep vein thrombosis or pulmonary emboli [40].…”

Section: Discussionmentioning

confidence: 99%

Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer

Abbema

Vissers

Vos‐Geelen

et al. 2019

Cancers

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Previous studies showed substantial improvement of survival rates in patients with cancer in the last two decades. However, lower survival rates have been reported for older patients compared to younger patients. In this population-based study, we analyzed treatment patterns and the survival of patients with breast cancer (BC) and colorectal cancer (CRC). Patients with stages I–III BC and CRC and diagnosed between 2003 and 2012 were selected from the Netherlands Cancer Registry (NCR). Trends in treatment modalities were evaluated with the Cochran-Armitage trend test. Trends in five-year overall survival were calculated with the Cox hazard regression model. The Ederer II method was used to calculate the five-year relative survival. The relative excess risk of death (RER) was estimated using a multivariate generalized linear model. During the study period, 98% of BC patients aged <75 years underwent surgery, whereas for patients ≥75 years, rates were 79.3% in 2003 and 66.7% in 2012 (p < 0.001). Most CRC patients underwent surgery irrespective of age or time period, although patients with rectal cancer aged ≥75 years received less surgery or radiotherapy over the entire study period than younger patients. The administration of adjuvant chemotherapy increased over time for CRC and BC patients, except for BC patients aged ≥75 years. The five-year relative survival improved only in younger BC patients (adjusted RER 0.95–0.96 per year), and was lower for older BC patients (adjusted RER 1.00, 95% Confidence Interval (CI) 0.98–1.02, and RER 1.00; 95% CI 0.98–1.01 per year for 65–74 years and ≥75 years, respectively). For CRC patients, the five-year relative survival improved over time for all ages (adjusted RER on average was 0.95 per year). In conclusion, the observed survival trends in BC and CRC patients suggest advances in cancer treatment, but with striking differences in survival between older and younger patients, particularly for BC patients.

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Hormone therapy in elderly breast cancer patients with comorbidities

Cited by 22 publications

References 60 publications

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

Current Targeted Therapies in Breast Cancer: Clinical Applications in the Elderly Woman

Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer

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