title: An update on adjuvant systemic therapy for elderly patients with early breast cancer.
abstract: BACKGROUND
  Elderly women with early breast cancer require an individualized approach to risk assessment and treatment. Unfortunately, there are limited data to inform optimal adjuvant therapy decisions in this population. Cytotoxic chemotherapy, biologic treatments and endocrine agents, while important in reducing breast cancer recurrence and mortality, are associated with the potential for adverse effects that may be of particular significance to elderly patients.
  
  
  METHODS
  In this review, we summarize the evidence for geriatric assessment in elderly patients with early breast cancer, outline special considerations for the use of chemotherapy and trastuzumab in older adults, and describe the age-specific risks of endocrine therapy in the adjuvant breast cancer setting.
  
  
  CONCLUSIONS
  The treatment of elderly women with early breast cancer should take into account cancer risk, life expectancy, comorbidities, functional status, physiologic changes, and patient values. Formal geriatric assessment may better inform treatment recommendations for individual patients. In general, there is no strong evidence to suggest that older women benefit less from standard adjuvant therapies than do their younger counterparts. When choosing between endocrine therapies, the differential risks associated with each agent should be considered and particular attention to the fracture risk on aromatase inhibitors (AIs) is warranted. Enrolment of women over 70 years of age into breast cancer clinical trials should be encouraged to better inform treatment guidelines.
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , Canada.
authors.forename: Katarzyna J
authors.initials: KJ
authors.lastname: Jerzak
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , Canada.
authors.forename: Danielle N
authors.initials: DN
authors.lastname: Desautels
authors.affiliation: a Department of Medicine , University of Toronto , Toronto , Canada.
authors.forename: Kathleen I
authors.initials: KI
authors.lastname: Pritchard
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors
keywords: Breast cancer; chemotherapy; elderly; endocrine therapy; risk assesment