Aromatase inhibitors in the treatment of elderly women with metastatic breast cancer

Abstract

The proportion of elderly women in the population is rising, and in tandem, the incidence of breast cancer rises with age. Because of health and tolerability concerns, as well as life expectancy, physicians may be reluctant to advise a standard treatment regimen for elderly patients with metastatic breast cancer. To elucidate this issue, we performed a literature review of clinical studies that included women with metastatic breast cancer who were over the age of 65. Our results show that although little clinical evidence exists, what is available suggests that standard treatment is tolerated and beneficial for patients meeting certain criteria. A geriatric assessment may identify specific patient groups (independent, dependent, or frail) and thereby guide treatment. Treatment recommendations for elderly patients with metastatic breast cancer are sparse, although first-line endocrine treatment, usually aromatase inhibitors or tamoxifen, is recommended for hormone-sensitive disease. In general, the evidence from clinical studies suggests that aromatase inhibitors are more effective than either tamoxifen or megestrol acetate as first- or second-line treatment in postmenopausal women with metastatic breast cancer. Ultimately, quality of life, treatment effects, and comorbidities are important aspects in this population and may guide treatment choice. To provide evidence-based treatment guidance, future clinical trials should include more patients over the age of 65 years.

Pharmacological blockade of the aromatase enzyme, but not the androgen receptor, reverses androstenedione-induced cognitive impairments in young surgically menopausal rats

“…Drugs that block the activity of the aromatase enzyme (Santen et al, 2009), which catalyzes the conversion of androstenedione to the estrogen estrone, are some of the tools used to treat metastatic breast cancer prevalent in menopausal women (Glück et al, 2013), as well as manage estrogen-dependent endometrial carcinoma (Gao et al, 2014). Here, we seek to decipher the hormone mechanism(s) underlying the negative cognitive impact of androstenedione using a rat model.…”

Mucinous carcinoma in an octogenarian: Treatment and management of breast cancer in the elderly

“…The benefits of chemotherapy have mainly been observed in ER negative cases [28] . Though the benefits and tolerability of endocrine therapy does not depend on age, research has shown chemotherapy tolerability decreases with age [ 28 , 29 ]. The recent 2021 Cancer and Aging Research Group-Breast Cancer (CARG-BC) score has been developed as a risk calculation tool to predict chemotherapy toxicity in treatment of early stage breast cancer in the elderly; the goal is to make chemotherapy a safer and more accessible treatment option in this group [30] .…”

Treating Elderly Patients with Hormone Receptor–Positive Advanced Breast Cancer

“…For women who are naive to treatment, or who have been off treatment for at least 1 year, aromatase inhibitors (AIs) would be considered first-line therapy. 41,[51][52][53][54][55][56][57][58] The same treatment is recommended for elderly patients diagnosed with HR+ breast cancer, 40,50,55 including those with diminished functional status. The AIs currently approved for use in advanced HR+ disease include anastrozole (Arimidex ® ), letrozole (Femara ® ), and exemestane (Aromasin ® ).…”