Korean J Med.  2014 Nov;87(5):542-547. 10.3904/kjm.2014.87.5.542.

Systemic Treatment of Older Patients with Advanced Breast Cancer

• Yoh KA
• Kim JH

• KMID: 2269194
• DOI: http://doi.org/10.3904/kjm.2014.87.5.542

Abstract

Due to its increasing incidence and longer life expectancy, more patients are being diagnosed with breast cancer at older ages. There are very limited data on the optimum management of older patients with advanced breast cancer, due to the under-representation of such individuals in clinical trials. Although older patients have more indolent disease with more Hormone Receptor positive disease and less HER2-positive disease, their disease-specific mortality remains lower than in younger patients, owing to the late diagnosis, under treatment due to age bias, reduced access to healthcare, and socioeconomic issues. Older patients with advanced breast cancer should be treated based on their biological tumor type, according to the patient's general health and preferences: endocrine treatment for HR-positive disease; Human Epidermal Growth Factor Receptor 2-targeted agent with chemotherapy, endocrine therapy or HER2-targeted agent alone for HER2 positive disease. Chemotherapy should be considered for patients who are HR-negative, HR-positive but refractory to endocrine treatment, or with a rapidly progressing visceral crisis. Generally, sequential chemotherapy with a single agent is recommended over combination chemotherapy, and agents with known toxicities in older patients are recommended, including weekly taxane, vinorelbine, capecitabine, and liposomal doxorubicin. Some form of geriatric assessment should be performed for older patients to assess the patients' biological age, functional status, and address age-specific problems, leading to early interventions. The goal of therapy should be individualized to maintain the quality of life, function, and independence of older patients with cancer.

Keyword

Elderly; Breast cancer; Chemotherapy

MeSH Terms

Aged
Bias (Epidemiology)
Breast Neoplasms*
Delayed Diagnosis
Delivery of Health Care
Doxorubicin
Drug Therapy
Drug Therapy, Combination
Early Intervention (Education)
Geriatric Assessment
Humans
Incidence
Life Expectancy
Mortality
Quality of Life
Receptor, Epidermal Growth Factor
Capecitabine
Doxorubicin
Receptor, Epidermal Growth Factor