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22-11-2016 | Breast cancer | Article

Adjuvant chemotherapy and HER-2-directed therapy for early-stage breast cancer in the elderly

Authors:
J Sun, S Chia

Abstract

There is a lack of sufficient evidence-based data defining the optimal adjuvant systemic therapies in older women. Recommendations are mainly based on retrospective studies, subgroup analyses within larger randomised trials and expert opinion. Treatment decisions should consider the functional fitness of the patient, co-morbidities, in addition to chronological age with the aim to balance risks and potential benefits from treatment(s). In this review, we discuss assessment tools to aid clinicians to select elderly patients who are ‘fit’ for chemotherapy, and review the literature on the use of chemotherapy and of the anti-HER 2 antibody trastuzumab in this population. We will also review two commonly used prediction models to assess their accuracy in predicting survival outcomes in elderly patients. Ongoing clinical trials specifically focusing on older patients may help to clarify the absolute benefits and risks of adjuvant systemic therapy in this age group.

Br J Cancer 2017; 116: 4–9. doi:10.1038/bjc.2016.360

Keywords: breast cancer; functional assessment; elderly; adjuvant chemotherapy; trastuzumab; prediction tool

Breast cancer is the most common female malignancy diagnosed worldwide (Ferlay et al, 2015). Women aged 65 and over account for two-fifths of all breast cancer diagnoses (SEER Cancer Statistics Review, 1975-2012, 2015). As the population ages, the number of new breast cancers in older individuals is also expected to increase. Despite this, there is a lack of level I evidence on how to optimally treat early-stage breast cancer in elderly women, owing to relatively poor representation and accrual in clinical trials. There is also no universally defined age cutoff for what constitutes as ‘elderly’. Some have considered the age of 70 to be the milestone age, stating that after this age there are significantly increased age-related physiological changes (Pallis et al, 2010). Others, such as the European Medicines Agency, consider 65 years old to be the cutoff age (Pallis et al, 2010). The aim of this review paper is to summarise available published research and guidelines on chemotherapy and anti-HER 2 therapy in the treatment of elderly women with early-stage breast cancer.

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