Taxanes in the elderly patient with metastatic breast cancer

Abstract

Denise A Yardley Sarah Cannon Research Institute, Nashville, TN, USA Abstract: More than 40% of all breast cancer cases are diagnosed in patients aged ≥65 years, accounting for an ever-increasing disease burden in the elderly. Historically, however, this growing population of breast cancer patients has been underrepresented in clinical trials, resulting in a paucity of data that clinicians can reference in making treatment decisions for their older patients. A consequence may be the undertreatment of elderly patients, who have the highest incidence of breast cancer. However, subgroup analyses of elderly patients in multiple early-Phase (I or II) studies and a handful of small studies with elderly-specific populations have suggested that older patients may experience similar benefit from cancer therapy as younger patients with otherwise similar baseline characteristics. Although steps should be taken to avoid undertreating older patients, a balance must be achieved to avoid overtreatment. Guidelines have been released detailing recommendations for the treatment of elderly breast cancer patients, including a discussion of various geriatric assessments that might aid physicians in selecting patients appropriate for recommended treatment options. Chemotherapy remains a key component of treatment regimens for many older patients. However, the benefit of some agents may be limited by tolerability issues. Taxanes, one of the most established classes of chemotherapy for breast cancer, are known to be highly active and efficacious and to have well-characterized safety profiles. This review discusses factors that influence treatment choices for elderly patients with metastatic breast cancer, and then focuses on clinical data for taxanes in this patient population. Keywords: breast cancer, elderly, taxane, chemotherapy, treatment guidelines