Treatment of advanced breast cancer in elderly women: medical approach

Abstract

Breast cancer is the most common malignancy in women worldwide, and represents the leading cause of death in the female population. Incidence of breast cancer increases with age, and older patients are more likely to have disseminated disease at diagnosis. The majority of breast cancer in older women is hormone-receptor positive, therefore, endocrine treatment with tamoxifen or aromatase inhibitors must be considered as first choice. For those patients who relapse after endocrine treatment or in whom the tumor does not express hormone receptors, chemotherapy should be considered. Single-agent sequential regimens should be preferred to combination regimens, which are usually more toxic and provide a limited survival gain. Trastuzumab in association with chemotherapy can be administered to elderly patients who present with HER2-overexpressing tumors, although cardiac monitoring is necessary owing to cardiac adverse events. Some geriatric assessment tools could help in qualifying those patients who can be treated with conventional therapy from those who should receive adjusted regimens, and from those who are frail and should be managed with the best supportive care.