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Treatment of metastatic breast cancer in older women

Author
Gretchen Kimmick, MD, MS
Section Editor
Daniel F Hayes, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Despite advances in primary and adjuvant treatment for local breast cancer, many patients will experience metastatic disease. In addition, 1 to 5 percent of women with breast cancer have metastatic disease at presentation. Although patients with metastatic breast cancer are unlikely to be cured of their disease, survival has improved over time due to improved options for treatment. As an example, compared with women treated from 1991 to 1992, those treated from 1999 to 2001 had a statistically longer survival (median, 22 versus 15 months) [1].

This topic will address issues pertinent to systemic antitumor treatment in older women (typically defined as age >65 years) with metastatic breast cancer. General principles that guide treatment of metastatic breast cancer in all populations, as well as more extensive discussions of endocrine therapy and chemotherapy for metastatic disease, are discussed in detail elsewhere.

(See "Systemic treatment for metastatic breast cancer: General principles".)

(See "Treatment approach to metastatic hormone receptor-positive, HER2-negative breast cancer: Endocrine therapy".)

(See "Systemic treatment of metastatic breast cancer in women: Chemotherapy".)

                

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Literature review current through: Jul 2017. | This topic last updated: Apr 20, 2017.
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References
Top
  1. Chia SK, Speers CH, D'yachkova Y, et al. The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer 2007; 110:973.
  2. Extermann M. Basic assessment of the older cancer patient. Curr Treat Options Oncol 2011; 12:276.
  3. Trimble EL, Carter CL, Cain D, et al. Representation of older patients in cancer treatment trials. Cancer 1994; 74:2208.
  4. Hutchins LF, Unger JM, Crowley JJ, et al. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 1999; 341:2061.
  5. Kemeny MM, Peterson BL, Kornblith AB, et al. Barriers to clinical trial participation by older women with breast cancer. J Clin Oncol 2003; 21:2268.
  6. Kimmick GG, Peterson BL, Kornblith AB, et al. Improving accrual of older persons to cancer treatment trials: a randomized trial comparing an educational intervention with standard information: CALGB 360001. J Clin Oncol 2005; 23:2201.
  7. Freedman RA, Foster JC, Seisler DK, et al. Accrual of Older Patients With Breast Cancer to Alliance Systemic Therapy Trials Over Time: Protocol A151527. J Clin Oncol 2017; 35:421.
  8. Hess D, Thürlimann B, Pagani O, et al. Capecitabine and vinorelbine in elderly patients (> or =65 years) with metastatic breast cancer: a phase I trial (SAKK 25/99). Ann Oncol 2004; 15:1760.
  9. Du X, Goodwin JS. Increase of chemotherapy use in older women with breast carcinoma from 1991 to 1996. Cancer 2001; 92:730.
  10. Schneider M, Zuckerman IH, Onukwugha E, et al. Chemotherapy treatment and survival in older women with estrogen receptor-negative metastatic breast cancer: a population-based analysis. J Am Geriatr Soc 2011; 59:637.
  11. Hancke K, Denkinger MD, König J, et al. Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German clinical cohort study. Ann Oncol 2010; 21:748.
  12. Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011; 29:3457.
  13. Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 2012; 118:3377.
  14. Aapro M, Monfardini S, Jirillo A, Basso U. Management of primary and advanced breast cancer in older unfit patients (medical treatment). Cancer Treat Rev 2009; 35:503.
  15. Hamberg P, Verweij J, Seynaeve C. Cytotoxic therapy for the elderly with metastatic breast cancer: a review on safety, pharmacokinetics and efficacy. Eur J Cancer 2007; 43:1514.
  16. Wilcken N, Dear R. Chemotherapy in metastatic breast cancer: A summary of all randomised trials reported 2000-2007. Eur J Cancer 2008; 44:2218.
  17. Carrick S, Parker S, Thornton CE, et al. Single agent versus combination chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev 2009; :CD003372.
  18. Barinoff J, Traut A, Bauerschlag D, et al. Chemotherapy for 70-Year-Old Women with Breast Cancer in Germany: A Survey by the German Breast Group. Geburtshilfe Frauenheilkd 2013; 73:433.
  19. Cardoso F, Bedard PL, Winer EP, et al. International guidelines for management of metastatic breast cancer: combination vs sequential single-agent chemotherapy. J Natl Cancer Inst 2009; 101:1174.
  20. Debled M, Madranges N, Mertens C, et al. First-line chemotherapy for metastatic breast cancer in patients ≥75 years: a retrospective single-centre analysis. Crit Rev Oncol Hematol 2011; 80:171.
  21. Ibrahim NK, Frye DK, Buzdar AU, et al. Doxorubicin-based chemotherapy in elderly patients with metastatic breast cancer. Tolerance and outcome. Arch Intern Med 1996; 156:882.
  22. Ibrahim NK, Hortobagyi GN, Ewer M, et al. Doxorubicin-induced congestive heart failure in elderly patients with metastatic breast cancer, with long-term follow-up: the M.D. Anderson experience. Cancer Chemother Pharmacol 1999; 43:471.
  23. Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer 2003; 97:2869.
  24. Aapro M, Bernard-Marty C, Brain EG, et al. Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper. Ann Oncol 2011; 22:257.
  25. O'Brien ME, Wigler N, Inbar M, et al. Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX/Doxil) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. Ann Oncol 2004; 15:440.
  26. Coleman RE, Biganzoli L, Canney P, et al. A randomised phase II study of two different schedules of pegylated liposomal doxorubicin in metastatic breast cancer (EORTC-10993). Eur J Cancer 2006; 42:882.
  27. Biganzoli L, Coleman R, Minisini A, et al. A joined analysis of two European Organization for the Research and Treatment of Cancer (EORTC) studies to evaluate the role of pegylated liposomal doxorubicin (Caelyx) in the treatment of elderly patients with metastatic breast cancer. Crit Rev Oncol Hematol 2007; 61:84.
  28. Bajetta E, Procopio G, Celio L, et al. Safety and efficacy of two different doses of capecitabine in the treatment of advanced breast cancer in older women. J Clin Oncol 2005; 23:2155.
  29. Kamal AH, Camacho F, Anderson R, et al. Similar survival with single-agent capecitabine or taxane in first-line therapy for metastatic breast cancer. Breast Cancer Res Treat 2012; 134:371.
  30. Sorio R, Robieux I, Galligioni E, et al. Pharmacokinetics and tolerance of vinorelbine in elderly patients with metastatic breast cancer. Eur J Cancer 1997; 33:301.
  31. Vogel C, O'Rourke M, Winer E, et al. Vinorelbine as first-line chemotherapy for advanced breast cancer in women 60 years of age or older. Ann Oncol 1999; 10:397.
  32. Addeo R, Sgambato A, Cennamo G, et al. Low-dose metronomic oral administration of vinorelbine in the first-line treatment of elderly patients with metastatic breast cancer. Clin Breast Cancer 2010; 10:301.
  33. Hainsworth JD, Burris HA 3rd, Yardley DA, et al. Weekly docetaxel in the treatment of elderly patients with advanced breast cancer: a Minnie Pearl Cancer Research Network phase II trial. J Clin Oncol 2001; 19:3500.
  34. D'hondt R, Paridaens R, Wildiers H, et al. Safety and efficacy of weekly docetaxel in frail and/or elderly patients with metastatic breast cancer: a phase II study. Anticancer Drugs 2004; 15:341.
  35. ten Tije AJ, Smorenburg CH, Seynaeve C, et al. Weekly paclitaxel as first-line chemotherapy for elderly patients with metastatic breast cancer. A multicentre phase II trial. Eur J Cancer 2004; 40:352.
  36. Del Mastro L, Perrone F, Repetto L, et al. Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer). Ann Oncol 2005; 16:253.
  37. Lichtman SM, Hurria A, Cirrincione CT, et al. Paclitaxel efficacy and toxicity in older women with metastatic breast cancer: combined analysis of CALGB 9342 and 9840. Ann Oncol 2012; 23:632.
  38. Hurria A, Fleming MT, Baker SD, et al. Pharmacokinetics and toxicity of weekly docetaxel in older patients. Clin Cancer Res 2006; 12:6100.
  39. Beuselinck B, Wildiers H, Wynendaele W, et al. Weekly paclitaxel versus weekly docetaxel in elderly or frail patients with metastatic breast carcinoma: a randomized phase-II study of the Belgian Society of Medical Oncology. Crit Rev Oncol Hematol 2010; 75:70.
  40. Gradishar WJ, Tjulandin S, Davidson N, et al. Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol 2005; 23:7794.
  41. Gradishar WJ, Krasnojon D, Cheporov S, et al. Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. J Clin Oncol 2009; 27:3611.
  42. Freedman RA, Muss HB. Managing metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer in the older patient. J Geriatr Oncol 2014; 5:2.
  43. Kaufman PA, Brufsky AM, Mayer M, et al. Treatment patterns and clinical outcomes in elderly patients with HER2-positive metastatic breast cancer from the registHER observational study. Breast Cancer Res Treat 2012; 135:875.
  44. Griffiths RI, Lalla D, Herbert RJ, et al. Infused therapy and survival in older patients diagnosed with metastatic breast cancer who received trastuzumab. Cancer Invest 2011; 29:573.
  45. Dees EC, O'Reilly S, Goodman SN, et al. A prospective pharmacologic evaluation of age-related toxicity of adjuvant chemotherapy in women with breast cancer. Cancer Invest 2000; 18:521.
  46. Repetto L. Greater risks of chemotherapy toxicity in elderly patients with cancer. J Support Oncol 2003; 1:18.
  47. Balducci L, Lyman GH. Patients aged > or = 70 are at high risk for neutropenic infection and should receive hemopoietic growth factors when treated with moderately toxic chemotherapy. J Clin Oncol 2001; 19:1583.
  48. Aapro M, Schwenkglenks M, Lyman GH, et al. Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy. Crit Rev Oncol Hematol 2010; 74:203.
  49. Tralongo P, Repetto L, Di Mari A, et al. Safety of long-term administration of bisphosphonates in elderly cancer patients. Oncology 2004; 67:112.
  50. Schilcher J, Michaëlsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 2011; 364:1728.
  51. Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 2011; 305:783.
  52. Liu L, Li C, Yang P, et al. Association between alendronate and atypical femur fractures: a meta-analysis. Endocr Connect 2015; 4:58.
  53. Kim YS, Park WC. Atypical subtrochanteric femur fracture in patient with metastatic breast cancer treated with zoledronic Acid. J Breast Cancer 2012; 15:261.
  54. van de Water W, Bastiaannet E, Egan KM, et al. Management of primary metastatic breast cancer in elderly patients--an international comparison of oncogeriatric versus standard care. J Geriatr Oncol 2014; 5:252.