Expert consensus to optimize the treatment of elderly patients with luminal metastatic breast cancer

Abstract

Most patients diagnosed with luminal metastatic breast cancer (MBC) who are seen in oncology consultations are elderly. MBC in elderly patients is characterized by a higher percentage of hormone receptor (HR) expression and a lower expression of human epidermal growth factor receptor 2 (HER2). The decision regarding which treatment to administer to these patients is complex due to the lack of solid evidence to support the decision-making process. The objective of this paper is to review the scientific evidence on the treatment of elderly patients with luminal MBC. For this purpose, the Oncogeriatrics Section of the Spanish Society of Medical Oncology (SEOM), the Spanish Breast Cancer Research Group (GEICAM) and the SOLTI Group appointed a group of experts who have worked together to establish consensus recommendations to optimize the treatment of this population. It was concluded that the chronological age of the patient alone should not guide therapeutic decisions and that a Comprehensive Geriatric Assessment (CGA) should be performed whenever possible before establishing treatment. Treatment selection for the elderly population should consider the patient’s baseline status, the expected benefit and toxicity of each treatment, and the impact of treatment toxicity on the patient’s quality of life and functionality.

Adjuvant chemotherapy and survival outcomes in older women with HR+/HER2− breast cancer: a propensity score-matched retrospective cohort study using the SEER database

“…Many older women with HR+/HER2− BC are diagnosed with stage II–III disease 25. There is no consensus definition for elderly patients; however, in the context of clinical trials, female patients older than 65 years old are usually considered older women 26. This group is less likely to receive guideline-concordant treatment, including chemotherapy, partly due to their reduced tolerance to treatment 27–30.…”

“…25 There is no consensus definition for elderly patients; however, in the context of clinical trials, female patients older than 65 years old are usually considered older women. 26 This group is less likely to receive guideline-concordant treatment, including chemotherapy, partly due to their reduced tolerance to treatment. [27][28][29][30] Comorbidities and geriatric syndromes such as cardiovascular and cerebrovascular diseases, functional cognitive impairment, malnutrition polypharmacy, psychological distress and diabetes have been shown to lower the ability of patients to tolerate chemotherapy.…”

Real-world treatment patterns and effectiveness of palbociclib plus an aromatase inhibitor in patients with metastatic breast cancer aged 75 years or older

“…Treatment decision-making for elderly patients with HR+/HER2− mBC requires particularly careful consideration of many factors, including comorbidities, possible drug-drug interactions, functional status, and the likelihood of drug-induced toxicities ( 25 , 26 ). Unfortunately, data to inform the clinical management of elderly patients are limited because these patients are generally underrepresented in clinical trials in oncology ( 5 – 7 ).…”

“…Toxicity management is particularly important when treating elderly patients with HR+/HER2− mBC ( 25 , 26 ). For example, postponing the initiation of salvage chemotherapy can help spare patients from the toxicities and detrimental effects on quality of life associated with chemotherapy ( 25 , 36 ). In our study, TTC was significantly prolonged with palbociclib plus an AI versus an AI alone before and after sIPTW and PSM adjustment.…”

“…Treating elderly patients with mBC presents many challenges, including frequent comorbidities, increased risk of drug-induced toxicity, and concerns regarding polypharmacy and drug-drug interactions ( 25 , 26 ). Therefore, more robust long-term data from large real-world studies are needed to better understand dosing patterns and clinical outcomes of elderly patients with HR+/HER2− mBC receiving 1L palbociclib plus an AI in routine clinical practice, especially among those aged ≥ 75 years.…”