Systemic therapy for older patients with early breast cancer. (November 2021)

• Record Type: Journal Article
• Authors: Battisti, Nicolò Matteo Luca; Joshi, Kroopa; Nasser, Mariam Syeda; Ring, Alistair
• Is Part Of: Cancer treatment reviews. Volume 100(2021)
• Publication Date: 2021-11
• Subjects: Early breast cancer -- Elderly -- Systemic therapy; Cancer -- Periodicals; Cancer -- Treatment -- Periodicals; Neoplasms -- therapy -- Periodicals; Cancer -- Périodiques; Cancer -- Traitement -- Périodiques; Cancer -- Treatment; Electronic journals; Periodicals; 616.99406
• DOI: 10.1016/j.ctrv.2021.102292
• Languages: English
• ISSNs: 0305-7372

Abstract

Highlights: The evidence base for chemotherapy use in older patients with early breast cancer is limited. The available data support use in patients with higher risk (including ER-negative) breast cancer. Chemotherapy has a significant but temporary impact on quality of life in this cohort. Specific tools can predict chemotherapy complications for older early breast cancer patients. Ongoing clinical trials investigate systemic anticancer therapies in older breast cancer patients. Abstract: Over a third of breast cancers are diagnosed in patients ≥70 years. With the ageing of the population, the number of older breast cancer patients will continue to rise. Older patients are under-represented in clinical studies underpinning breast cancer therapy, and frequently do not receive guideline-concordant care. This review outlines the evidence on the efficacy and the safety of systemic treatment options for the management of early-stage breast cancer (EBC) in older adults and identifies where critical data gaps exist. Chemotherapy is beneficial for older patients with oestrogen receptor (ER)-negative EBC, whilst the benefit for those with ER-positive disease is less certain. Careful consideration should be given to the side-effect profile of the treatment regimen chosen, owing to the risks of myelosuppression and cardiac damage, as well as toxicities, such as neuropathy, that may impact independence. The impact of chemotherapy on quality of life (QOL) outcomes appears significant but reversible in this population. Gene expression profiling, benefit and chemotherapy toxicity prediction tools integrating global health considerations hold promise to better inform chemotherapy decisions in this population. Benefits on targeted anti-human epidermal growth factor receptor 2 (HER2) agents is maintained in older EBC patients with a favourable safety profile. Endocrine therapy including aromatase inhibitors is the standard of care in this population, and extended treatment decisions should consider effects on bone health and life expectancy. More trials recruiting older adults with pragmatic designs and meaningful endpoints for this population are warranted to better inform systemic treatment decisions and discussion with patients.