Taxanes in the elderly patient with metastatic breast cancer

Abstract

More than 40% of all breast cancer cases are diagnosed in patients aged ≥65 years, accounting for an ever-increasing disease burden in the elderly. Historically, however, this growing population of breast cancer patients has been underrepresented in clinical trials, resulting in a paucity of data that clinicians can reference in making treatment decisions for their older patients. A consequence may be the undertreatment of elderly patients, who have the highest incidence of breast cancer. However, subgroup analyses of elderly patients in multiple early-Phase (I or II) studies and a handful of small studies with elderly-specific populations have suggested that older patients may experience similar benefit from cancer therapy as younger patients with otherwise similar baseline characteristics. Although steps should be taken to avoid undertreating older patients, a balance must be achieved to avoid overtreatment. Guidelines have been released detailing recommendations for the treatment of elderly breast cancer patients, including a discussion of various geriatric assessments that might aid physicians in selecting patients appropriate for recommended treatment options. Chemotherapy remains a key component of treatment regimens for many older patients. However, the benefit of some agents may be limited by tolerability issues. Taxanes, one of the most established classes of chemotherapy for breast cancer, are known to be highly active and efficacious and to have well-characterized safety profiles. This review discusses factors that influence treatment choices for elderly patients with metastatic breast cancer, and then focuses on clinical data for taxanes in this patient population.

Paclitaxel’s Mechanistic and Clinical Effects on Breast Cancer

“…Taxanes and alkaloids are chemotherapy drugs derived from plants. Taxanes (PTX, Cabazitaxel and Docetaxel) represent the most applied chemotherapy approaches and along with anthracyclines are the first line of treatment for patients with metastatic as well as early-stage BC [54]. Importantly, certain dominant-negative mutations of genes associated with the regulation of mitosis are responsible for the development of resistance of cancer cells, and thus the effectiveness of taxane therapy is decreased [55].…”

Chemotherapy and 21-gene recurrence score testing for older breast cancer patients: A competing-risks analysis

“…In addition, older persons have higher death from other causes. Moreover, older persons in the United States have different preferences for chemotherapy as they age [13,14]. Therefore, the chemotherapy effect in older patients based on the RS classification needed further exploration.…”

“…In particular, the first validation study indicated that age was not an independent prognostic factor when RS was included in the multivariate analysis [3]. Several studies have shown that older women were often not treated with guideline-recommended chemotherapy or were undertreated, which could lead to a higher risk of BC-related mortality compared to younger women [13,14]. Therefore, treatment should be adapted to tumor biology and general health rather than age alone.…”

Real-World Analysis of Medical Costs and Healthcare Resource Utilization in Elderly Women with HR+/HER2− Metastatic Breast Cancer Receiving Everolimus-Based Therapy or Chemotherapy

“…Elderly patients are more likely to develop BC of the hormone-receptor-positive (HR? ), human epidermal growth factor receptor-2-negative (HER2-) subtype compared to younger patients [8]. This is mainly explained by HR positivity increasing with age and being common among post-menopausal women [9].…”

“…Older patients are also less likely to have HER2-overexpressing BC due the declining number of growth factor receptors with age [8].…”