Open AccessCurrent Targeted Therapies in Breast Cancer: Clinical Applications in the Elderly Woman
Author(s) -
Spano JeanPhilippe,
Falandry Claire,
Chaibi Pascal,
Freyer Gilles
Publication year - 2011
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2011-0028
Subject(s) - medicine , breast cancer , trastuzumab , lapatinib , docetaxel , oncology , cancer , metastatic breast cancer , capecitabine , bevacizumab , population , geriatric oncology , chemotherapy , colorectal cancer , environmental health
Learning Objectives After completing this course, the reader will be able to: Include geriatric assessment into oncologic practice to describe patients and to evaluate the real benefit/risk ratio of any adjuvant treatment. Describe the actual risk of association of erythropoiesis‐stimulating agents with bevacizumab.This article is available for continuing medical education credit at CME.TheOncologist.com The incidence of breast cancer is two to three times higher in women aged ≥65 years than in the whole population, whereas their mortality rate is threefold to fourfold higher. Targeted therapies allow significantly longer disease‐free survival times. Nevertheless, in an elderly population, these treatments need to be prescribed with caution. This paper reviews the treatments of breast cancer in the elderly, and the issues of targeted therapies and their toxicities. Patients with human epidermal growth factor receptor (HER)‐2 + breast cancer benefit from trastuzumab; although cardiotoxic effects are observed in <5% of patients when given alone, they affect ∼25% of patients when combined with anthracyclines. Bevacizumab leads to a longer progression‐free survival time and lower risk for progression in patients with metastatic breast cancer when added to paclitaxel or docetaxel. Although generally well tolerated, it is associated with a higher risk for arterial thromboembolism and hypertension. Lapatinib is approved for the treatment of advanced or metastatic breast cancer in patients not responding to trastuzumab, combined with capecitabine chemotherapy. The most frequent side effects concern the gastrointestinal system and dermatologic symptoms. The life expectancy of breast cancer patients should be taken into account to determine the appropriateness of treatments. The quality of life of elderly cancer patients must be assessed with an appropriate tool. Older patients exhibit greater vulnerability, suggesting identification and exclusion of patients at high cardiac risk. Future recommendations for the treatment of elderly women with breast cancer should include a multidisciplinary approach and a global geriatric assessment before treatment with anti–HER‐2 therapy or bevacizumab.