Systemic treatment of metastatic breast cancer in older adults

Abstract

The management of older adults with breast cancer poses a challenging dilemma to most treating oncologists given the underrepresentation of older age groups in most pivotal clinical trials. Older patients are at risk of undertreatment, which may be due to physician bias and/or patient preference. There is mounting evidence suggesting that older patients with breast cancer may derive as much benefit from treatment as their younger counterparts. However, generalizing treatment for all older breast cancer patients without further health assessment poses the risk of over-treatment. Although the efficacy outcomes may be similar across age groups, the tolerance to toxicity may differ, as determined mostly by comorbidities, organ function, and aging heterogeneity. In metastatic breast cancer, the main goal of care is to offer the least toxic treatment that can control symptoms, prolong survival, and preserve the quality of life. Therefore, defining the goals of treatment while carefully assessing the overall health status in addition to risk-benefit ratio is paramount to the treatment decisionmaking.