title: Aromatase inhibitors in the treatment of elderly women with metastatic breast cancer.
abstract: The proportion of elderly women in the population is rising, and in tandem, the incidence of breast cancer rises with age. Because of health and tolerability concerns, as well as life expectancy, physicians may be reluctant to advise a standard treatment regimen for elderly patients with metastatic breast cancer. To elucidate this issue, we performed a literature review of clinical studies that included women with metastatic breast cancer who were over the age of 65. Our results show that although little clinical evidence exists, what is available suggests that standard treatment is tolerated and beneficial for patients meeting certain criteria. A geriatric assessment may identify specific patient groups (independent, dependent, or frail) and thereby guide treatment. Treatment recommendations for elderly patients with metastatic breast cancer are sparse, although first-line endocrine treatment, usually aromatase inhibitors or tamoxifen, is recommended for hormone-sensitive disease. In general, the evidence from clinical studies suggests that aromatase inhibitors are more effective than either tamoxifen or megestrol acetate as first- or second-line treatment in postmenopausal women with metastatic breast cancer. Ultimately, quality of life, treatment effects, and comorbidities are important aspects in this population and may guide treatment choice. To provide evidence-based treatment guidance, future clinical trials should include more patients over the age of 65 years.
authors: Department of Medicine, Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Leonard M. Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136, USA. Electronic address: sgluck@med.miami.edu.
authors: Stefan
authors: S
authors: Glück
authors: German Breast Group, c/o GBG Forschungs GmbH, Neu-Isenburg and University Women's Hospital, Frankfurt, Germany.
authors: Gunter
authors: G
authors: von Minckwitz
authors: Clinic for Gynecology, Gynecologic Oncology and Obstetrics, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
authors: Michael
authors: M
authors: Untch
mesh_terms: D000369:Aged, 80 and over; D000077384:Anastrozole; D000730:Androstadienes / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D015897:Comorbidity; D019468:Disease Management; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D000077289:Letrozole; D008017:Life Expectancy; D009570:Nitriles / Q000627:therapeutic use; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000730:Androstadienes; D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D000077384:Anastrozole; D000077289:Letrozole; C056516:exemestane