Abstract
Older patients are one of the most relevant sub-groups of patients with breast cancer
and will only gain in importance as demographic transition unfolds. Their management,
in both the early and advanced settings, should take into consideration specific clinical
needs and is made more difficult by the limited availability of evidence on the efficacy
and safety of standard treatment regimens in older patients. At the root of this situation
is the low rate of participation of older patients in clinical trials, often due to
age limits for inclusion, and limitations on the participation of persons with significant
comorbidities or organ dysfunction. Although this has begun to change in recent years,
most agents currently in use have not been tested in a substantial number of older
patients. This includes the targeted agents that have, in the last fifteen years,
changed the prognosis of patients with early and advanced breast cancer. Most data
guiding the use of targeted agents in older patients come from sub-analysis of larger
trials or small retrospective cohort studies. The goal of this review is to go over
the available evidence regarding the efficacy and safety of targeted agents approved
for use in breast cancer (trastuzumab, lapatinib, T-DM1, pertuzumab, neratinib, palbociclib,
bevacizumab, ribociclib, abemaciclib, everolimus, olaparib, talazoparib), and place
their side effects into an older-specific context in order to help medical oncologists
when making treatment decisions and managing older patients with breast cancer.
Keywords
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Article info
Publication history
Published online: June 03, 2019
Accepted:
May 14,
2019
Received in revised form:
March 25,
2019
Received:
December 21,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
