Treating Elderly Patients with Hormone Receptor–Positive Advanced Breast Cancer

Abstract

As the overall population ages, the proportion of elderly patients (aged ≥65 years) with breast cancer also increases. Studies have shown that elderly patients with hormone receptor–positive breast cancer can derive as much benefit from treatment as do younger patients, yet they remain underrepresented in clinical trials and are often undertreated in clinical practice. Treatment decisions for older patients should not be based solely on chronologic age; a patient’s physiologic functioning and comorbidities must also be taken into consideration. For recurrent or metastatic disease, systemic treatment with endocrine therapies or chemotherapy may prolong a patient’s life and alleviate troublesome symptoms. Resistance to therapy remains a problem in the advanced breast cancer setting, with most patients eventually becoming resistant to additional treatment. New combination regimens that target multiple pathways, such as everolimus plus exemestane, have shown efficacy in elderly patients previously resistant to endocrine therapies, and future research may need to focus on such combinations in order to improve outcomes in this patient group. A number of investigational agents are in clinical development, although few studies identify their effects in the elderly patient population. Optimizing effective yet tolerable therapeutic regimens for elderly patients could improve their outcomes while ensuring that the goals of improved survival and quality of life are considered.

A European, Observational Study of Endocrine Therapy Administration in Patients With an Initial Diagnosis of Hormone Receptor-Positive Advanced Breast Cancer

“…19 Therefore, it would also be interesting to investigate endocrine therapy in this specific patient population, which might have fewer perceived treatment options. 20 …”

Ribociclib with letrozole vs letrozole alone in elderly patients with hormone receptor-positive, HER2-negative breast cancer in the randomized MONALEESA-2 trial

“…First-line treatment options for elderly patients with HR+ advanced breast cancer are similar for younger patients [ 3 ], where endocrine therapy is recommended for most cases in the absence of visceral crisis [ 4 – 7 ]. Use of other therapies, such as chemotherapy or some targeted agents, are often delayed in elderly patients owing to their challenging side-effect profiles.…”

“…Use of other therapies, such as chemotherapy or some targeted agents, are often delayed in elderly patients owing to their challenging side-effect profiles. Comorbidities such as hypertension, diabetes, and coronary disease are common in elderly patients and can impact therapy choice [ 3 , 8 ].…”

“…Although elderly patients with HR+ breast cancer derive benefits from treatment with endocrine monotherapies, the development of endocrine resistance remains a problem in this patient population [ 3 ]. New therapeutic approaches that delay development of endocrine therapy resistance and take into account comorbid illnesses, functional status, quality of life, and geriatric assessments are needed to improve the medical care and survival outcomes of older patients with HR+ advanced breast cancer [ 3 , 9 ].…”

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

“…Currently, the median age at the time of BC diagnosis is 61 years, with over 40% of patients aged 65 years or older [7]. Elderly patients are more likely to develop BC of the hormone-receptor-positive (HR?…”