Systemic Treatment of Older Patients with Advanced Breast Cancer.
10.3904/kjm.2014.87.5.542
- Author:
Kyung Ah YOH
1
;
Jee Hyun KIM
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Publication Type:Review
- Keywords:
Elderly;
Breast cancer;
Chemotherapy
- MeSH:
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
- From:Korean Journal of Medicine
2014;87(5):542-547
- CountryRepublic of Korea
- Language:Korean
-
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.
