Medical treatment of elderly patients with breast cancer

We performed a bibliographic electronic search of MEDLINE and Cochrane databases on breast cancer in the elderly. In the adjuvant setting aromatase inhibitors are more effective than tamoxifen with an acceptable profile of toxicity. In aged, poorer risk, patients adjuvant chemotherapy is feasible but organ function and comorbidities have to be considered. Adjuvant trastuzumab is also an option for the treatment of Her2 positive aged breast cancer. Neoadjuvant chemotherapy ± HER2-targeted treatment is today a possible treatment for triple negative and HER2-positive disease, respectively. Older women are more likely than younger women to present with more advanced breast cancer. Hormone therapy is the treatment of choice for older women with hormone receptor positive metastatic breast cancer until they develop resistance. When appropriate, polychemotherapy may be employed but unfortunately we have a lack of data on this matter. However, because fit women older than 70 years of age have similar results with chemotherapy as their younger counterparts most oncologists tend to propose this option to their patients. Trastuzumab has proven to be effective and well tolerated in elderly patients (older than 60-70 years), but caution is needed due to the risk of heart failure. Recently, an all-oral combination of capecitabine and vinorelbine demonstrated good acitivity and tolerability profile in patients older than 70 years. Nab-paclitaxel has shown a safer and more active profile compared with the q3w taxanes in such population. There is, therefore, an urgent need to study anticancer agents in the elderly within large randomized controlled trials.