Skip to main content

Advertisement

SpringerLink
Log in

Adjuvant Chemotherapy for Early Breast Cancer in the Elderly

  • Geriatric Oncology
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The use of cytotoxic therapy in the fit elderly breast cancer patient has been tempered with concerns of age, physical function, and co-morbid illness. In the appropriate patient with biologically aggressive disease, such as receptor poor breast cancer, it is reasonable to consider combination chemotherapy as part of an adjuvant program. If this approach is to be employed, the physician must also consider the patient’s co-morbid conditions and status of function in society as potential indicators of toxicity or lack of benefit. In this case, a formal geriatric assessment is of value. A Cancer and Leukemia Group B (CALGB) trial of monotherapy vs combination cytotoxic therapy as adjuvant treatment for localized breast cancer patients over 65 years of age has determined that the combination approach is superior to single agent therapy. In an unplanned analysis of receptor rich and receptor poor tumors, the patients with receptor poor tumors seemed to achieve the greatest benefit from combination cytotoxic therapy. Adjuvant chemotherapy can also be considered for patients with high-risk receptor rich breast cancers. However, the use of chemotherapy in the elderly patient with breast cancer is largely based upon data emerging from trials in younger patients. Studies specifically for patients over 65 years of age are urgently needed in this population to provide evidence-based proof of the current approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Balducci L: Aging, frailty, and chemotherapy. Cancer Control 2007; 14: 7-12.

    PubMed  Google Scholar 

  2. Carlson RW, Moench S, Hurria A, et al.: NCCN Task Force Report: breast cancer in the older woman. J Natl Compr Canc Netw 2008, 6 Suppl 4: S1-S25; quiz S26-S27.

    PubMed  Google Scholar 

  3. Hurria A, Lichtman SM, Gardes J, et al.: Identifying vulnerable older adults with cancer: integrating geriatric assessment into oncology practice. J Am Geriatr Soc 2007, 55: 1604-1608. doi:10.1111/j.1532-5415.2007.01367.x

    Article  PubMed  Google Scholar 

  4. http://www.census.gov. Accessed January 15, 2009

  5. Gracia M, Jemal A, Ward E, et al.: Global Cancer Facts and Figures 2007. American Cancer Society, Atlanta. 2007

  6. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71-96. doi:10.3322/CA.2007.0010

    Article  PubMed  Google Scholar 

  7. Crivellari D, Spazzapan S, Lombardi D, et al.: Treatment of older breast cancer patients with high recurrence risk. Crit Rev Oncol Hematol 2003, 46: 241-246. doi:10.1016/S1040-8428(03)00023-4

    Article  CAS  PubMed  Google Scholar 

  8. Budman D. Aging, Breast Cancer, and Toxicity. in Chemotherapy toxicity: Focus on the older cancer patient Lichtman S, ed. CMPMedica. London. 2008. p 23-44

    Google Scholar 

  9. Kornblith AB, Kemeny M, Peterson BL, et al.: Survey of oncologists’ perceptions of barriers to accrual of older patients with breast carcinoma to clinical trials. Cancer 2002, 95: 989-996. doi:10.1002/cncr.10792

    Article  PubMed  Google Scholar 

  10. Aapro MS, Kohne CH, Cohen HJ and Extermann M: Never too old? Age should not be a barrier to enrollment in cancer clinical trials. Oncologist 2005, 10: 198-204. doi:10.1634/theoncologist.10-3-198

    Article  PubMed  Google Scholar 

  11. Rossi A, Colantuoni G, Maione P, et al.: Chemotherapy of breast cancer in the elderly. Curr Med Chem 2005, 12: 297-310.

    CAS  PubMed  Google Scholar 

  12. Lichtman S and Budman D. Eligibility of breast cancer trials. New Engl J Med 1989; 321: 470

    Google Scholar 

  13. Di Costanzo F, Gasperoni S and Di Costanzo F: Should adjuvant chemotherapy be used in elderly women (> or = 70 years) with breast cancer? Contra. Tumori 2002, 88: S91-92

    PubMed  Google Scholar 

  14. Fisher B, Jeong JH, Bryant J, et al.: Treatment of lymph-node-negative, oestrogen-receptor-positive breast cancer: long-term findings from National Surgical Adjuvant Breast and Bowel Project randomised clinical trials. Lancet 2004, 364: 858-868. doi:10.1016/S0140-6736(04)16981-X

    Article  CAS  PubMed  Google Scholar 

  15. Diab SG, Elledge RM and Clark GM: Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 2000, 92: 550-556. doi:10.1093/jnci/92.7.550

    Article  CAS  PubMed  Google Scholar 

  16. Muss HB. Factors used to select adjuvant therapy of breast cancer in the United States: an overview of age, race, and socioeconomic status. J Natl Cancer Inst Monogr 2001; 30 52–55

    PubMed  Google Scholar 

  17. Muss HB, Woolf S, Berry D, et al.: Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. Jama 2005, 293: 1073-1081. doi:10.1001/jama.293.9.1073

    Article  CAS  PubMed  Google Scholar 

  18. Wildiers H, Kunkler I, Biganzoli L, et al.: Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol 2007, 8: 1101-1115. doi:10.1016/S1470-2045(07)70378-9

    Article  PubMed  Google Scholar 

  19. Early Breast Cancer Trialist’s Group: Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005, 365:1687–1717. doi:10.1016/S0140-6736(05)66544-0

    Google Scholar 

  20. Clarke M: Meta-analyses of adjuvant therapies for women with early breast cancer: the Early Breast Cancer Trialists’ Collaborative Group overview. Ann Oncol 2006, 17 Suppl 10: x59-62. doi:10.1093/annonc/mdl238

    Article  PubMed  Google Scholar 

  21. Clarke M, Coates AS, Darby SC, et al.: Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials. Lancet 2008, 371: 29-40. doi:10.1016/S0140-6736(08)60196-8

    Article  CAS  PubMed  Google Scholar 

  22. Brunello A, Basso U, Pogliani C, et al. Adjuvant chemotherapy for elderly patients (> or = 70 years) with early high-risk breast cancer: a retrospective analysis of 260 patients. Ann Oncol 2005; 16: 1276-1282. doi:10.1093/annonc/mdi257

    Article  CAS  PubMed  Google Scholar 

  23. Elkin EB, Hurria A, Mitra N, et al.: Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol 2006, 24: 2757-2764. doi:10.1200/JCO.2005.03.6053

    Article  PubMed  Google Scholar 

  24. Giordano SH, Duan Z, Kuo YF, et al.: Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol 2006, 24: 2750-2756. doi:10.1200/JCO.2005.02.3028

    Article  PubMed  Google Scholar 

  25. Loibl S, von Minckwitz G, Harbeck N, et al. Clinical feasibility of (neo)adjuvant taxane-based chemotherapy in older patients: analysis of > 4,500 patients from four German randomized breast cancer trials. Breast Cancer Res 2008; 10: R77. doi:10.1186/bcr2144

    Article  PubMed  Google Scholar 

  26. Wildiers H: Challenges in treating older cancer patients: breast cancer. Ann Oncol 2008, 19 Suppl 7: vii99-103. doi:10.1093/annonc/mdn481

    Article  PubMed  Google Scholar 

  27. Citron ML. Dose-dense chemotherapy for node-positive breast cancer. Ann Intern Med 2005; 142: 227

    PubMed  Google Scholar 

  28. Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 2003; 21: 1431-1439. doi:10.1200/JCO.2003.09.081

    Article  CAS  PubMed  Google Scholar 

  29. Bernardi D, Errante D, Gallligioni E, et al.: Treatment of breast cancer in older women. Acta Oncol 2008, 47: 187-198. doi:10.1080/02841860701630234

    Article  PubMed  Google Scholar 

  30. Jones SE, Savin MA, Holmes FA, et al.: Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. J Clin Oncol 2006, 24: 5381-5387. doi:10.1200/JCO.2006.06.5391

    Article  CAS  PubMed  Google Scholar 

  31. Goldstein LJ, O’Neill A, Sparano JA, et al. Concurrent doxorubicin plus docetaxel is not more effective than concurrent doxorubicin plus cyclophosphamide in operable breast cancer with 0 to 3 positive axillary nodes: North American Breast Cancer Intergroup Trial E 2197. J Clin Oncol 2008; 26: 4092-4099. doi:10.1200/JCO.2008.16.7841

    Article  CAS  PubMed  Google Scholar 

  32. Sparano JA, Wang M, Martino S, et al.: Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med 2008, 358: 1663-1671. doi:10.1056/NEJMoa0707056

    Article  CAS  PubMed  Google Scholar 

  33. Fargeot P, Bonneterre J, Roche H, et al. Disease-free survival advantage of weekly epirubicin plus tamoxifen versus tamoxifen alone as adjuvant treatment of operable, node-positive, elderly breast cancer patients: 6-year follow-up results of the French adjuvant study group 08 trial. J Clin Oncol 2004; 22: 4622-4630. doi:10.1200/JCO.2004.02.145

    Article  PubMed  Google Scholar 

  34. Pagani O, Gelber S, Simoncini E, et al.: Is adjuvant chemotherapy of benefit for postmenopausal women who receive endocrine treatment for highly endocrine-responsive, node-positive breast cancer? International Breast Cancer Study Group Trials VII and 12-93. Breast Cancer Res Treat 2009 (in press)

  35. Muss H, Berry D, Cirrincione C, et al. Standard chemotherapy (CMF or AC) versus capecitabine in early-stage breast cancer patients aged 65 and older: Results of CALGB/CTSU 49907. J Clin Oncol 2008; 26: 507a. doi:10.1200/JCO.2007.12.6334

    Article  Google Scholar 

  36. Slamon DJ, Godolphin W, Jones LA, et al. Studies of the HER-2/neu proto-oncogene in human breast and ovarian cancer. Science 1989; 244: 707-712. doi:10.1126/science.2470152

    Article  CAS  PubMed  Google Scholar 

  37. Durbecq V, Ameye L, Veys I, et al. A significant proportion of elderly patients develop hormone-dependant “luminal-B” tumours associated with aggressive characteristics. Crit Rev Oncol Hematol 2008; 67: 80-92. doi:10.1016/j.critrevonc.2007.12.008

    Article  CAS  PubMed  Google Scholar 

  38. Lin A and Rugo HS, The role of trastuzumab in early stage breast cancer: current data and treatment recommendations. Curr Treat Options Oncol 2007; 8: 47-60. doi:10.1007/s11864-007-0008-2

    Article  PubMed  Google Scholar 

  39. Nielsen DL, Andersson M, Kamby C: HER2-targeted therapy in breast cancer. Monoclonal antibodies and tyrosine kinase inhibitors. Cancer Treat Rev 2009, 35(2):121–136

    Google Scholar 

  40. Perez EA and Baweja M. HER2-positive breast cancer: current treatment strategies. Cancer Invest 2008; 26: 545-552. doi:10.1080/07357900801971024

    Article  PubMed  Google Scholar 

  41. Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005; 353: 1673-1684. doi:10.1056/NEJMoa052122

    Article  CAS  PubMed  Google Scholar 

  42. Smith I, Procter M, Gelber RD, et al. 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet 2007; 369: 29-36. doi:10.1016/S0140-6736(07)60028-2

    Article  CAS  PubMed  Google Scholar 

  43. Joensuu H, Kellokumpu-Lehtinen PL, Bono P, et al.: Adjuvant docetaxel or vinorelbine with or without trastuzumab for breast cancer. N Engl J Med 2006, 354: 809-820. doi:10.1056/NEJMoa053028

    Article  CAS  PubMed  Google Scholar 

  44. Spielmann M, Roche H, Delozier T, et al.: Safety analysis from PACS 04—a phase III trial comparing 6 cycles of FEC 100 with 6 cycles of ET75 for node-positive early breast cancer patients, followed by sequential trastuzumab in Her2+ patients: preliminary results. In: Proc Annul Meet Am Soc Clin Oncol; 2006, p. 632a

  45. Browall MM, Ahlberg KM, Persson LO, et al. The impact of age on Health-Related Quality of Life (HRQoL) and symptoms among postmenopausal women with breast cancer receiving adjuvant chemotherapy. Acta Oncol 2008; 47: 207-215. doi:10.1080/02841860701621258

    Article  PubMed  Google Scholar 

  46. Muss HB, Biganzoli L, Sargent DJ and Aapro M: Adjuvant therapy in the elderly: making the right decision. J Clin Oncol 2007, 25: 1870-1875. doi:10.1200/JCO.2006.10.3457

    Article  PubMed  Google Scholar 

  47. Extermann M, Overcash J, Lyman GH, et al.: Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 1998, 16: 1582-1587

    CAS  PubMed  Google Scholar 

  48. Albrand G and Terret C: Early breast cancer in the elderly: assessment and management considerations. Drugs Aging 2008, 25: 35-45.

    Article  CAS  PubMed  Google Scholar 

  49. Terret C, Castel-Kremer E, Albrand G and Droz JP: Effects of comorbidity on screening and early diagnosis of cancer in elderly people. Lancet Oncol 2009, 10: 80-87. doi:10.1016/S1470-2045(08)70336-X

    Article  PubMed  Google Scholar 

  50. Terret C, Zulian GB, Naiem A and Albrand G: Multidisciplinary approach to the geriatric oncology patient. J Clin Oncol 2007, 25: 1876-1881. doi:10.1200/JCO.2006.10.3291

    Article  PubMed  Google Scholar 

  51. Yancik R, Wesley MN, Ries LA, et al. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. Jama 2001; 285: 885-892. doi:10.1001/jama.285.7.885

    Article  CAS  PubMed  Google Scholar 

  52. Crivellari D, Bonetti M, Castiglione-Gertsch M, et al.: Burdens and benefits of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: the International Breast Cancer Study Group Trial VII. J Clin Oncol 2000, 18: 1412-1422.

    CAS  PubMed  Google Scholar 

  53. Nuzzo F, Morabito A, De Maio E, et al. Weekly docetaxel versus CMF as adjuvant chemotherapy for elderly breast cancer patients: safety data from the multicentre phase 3 randomised ELDA trial. Crit Rev Oncol Hematol 2008; 66: 171-180. doi:10.1016/j.critrevonc.2007.10.006

    Article  PubMed  Google Scholar 

  54. Hurria A, Hurria A, Brogan K, et al.: Effect of creatinine clearance on patterns of toxicity in older patients receiving adjuvant chemotherapy for breast cancer. Drugs Aging 2005, 22: 785-791. doi:10.2165/00002512-200522090-00007

    Article  CAS  PubMed  Google Scholar 

  55. Patt DA, Duan Z, Fang S, et al.: Acute myeloid leukemia after adjuvant breast cancer therapy in older women: understanding risk. J Clin Oncol 2007, 25: 3871-3876. doi:10.1200/JCO.2007.12.0832

    Article  PubMed  Google Scholar 

  56. Le Deley MC, Suzan F, Cutuli B, et al.: Anthracyclines, mitoxantrone, radiotherapy, and granulocyte colony-stimulating factor: risk factors for leukemia and myelodysplastic syndrome after breast cancer. J Clin Oncol 2007, 25: 292-300. doi:10.1200/JCO.2006.05.9048

    Article  CAS  PubMed  Google Scholar 

  57. Hershman D, Neugut AI, Jacobson JS, et al.: Acute myeloid leukemia or myelodysplastic syndrome following use of granulocyte colony-stimulating factors during breast cancer adjuvant chemotherapy. J Natl Cancer Inst 2007, 99: 196-205. doi:10.1093/jnci/djk028

    Article  CAS  PubMed  Google Scholar 

  58. Fumoleau P, Roche H, Kerbrat P, et al.: Long-term cardiac toxicity after adjuvant epirubicin-based chemotherapy in early breast cancer: French Adjuvant Study Group results. Ann Oncol 2006, 17: 85-92. doi:10.1093/annonc/mdj034

    Article  CAS  PubMed  Google Scholar 

  59. Ganz PA, Hussey MA, Moinpour CM, et al. Late cardiac effects of adjuvant chemotherapy in breast cancer survivors treated on Southwest Oncology Group protocol s8897. J Clin Oncol 2008; 26: 1223-1230. doi:10.1200/JCO.2007.11.8877

    Article  CAS  PubMed  Google Scholar 

  60. Leonard RC and Malinovszky KM. Chemotherapy for older women with early breast cancer. Clin Oncol (R Coll Radiol) 2005; 17: 244-248. doi:10.1016/j.clon.2005.02.002

    CAS  Google Scholar 

  61. Bonadonna G, Valagussa P, Moliterni A, et al. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of 20 years of follow-up. N Engl J Med 1995; 332: 901-906. doi:10.1056/NEJM199504063321401

    Article  CAS  PubMed  Google Scholar 

  62. Levine MN, Bramwell VH, Pritchard KI, et al.: Randomized trial of intensive cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1998, 16: 2651-2658

    CAS  PubMed  Google Scholar 

  63. Henderson IC, Berry DA, Demetri GD, et al.: Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 2003, 21: 976-983. doi:10.1200/JCO.2003.02.063

    Article  CAS  PubMed  Google Scholar 

  64. Martin M, Pienkowski T, Mackey J, et al.: Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 2005, 352: 2302-2313. doi:10.1056/NEJMoa043681

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Don Monti Division of Oncology, Monter Cancer Center, New York University, 450 Lakeville Road, Lake Success, NY, 11042, USA

    Mary Leung MD, Iulianna Shapira MD, Thomas Bradley MD & Daniel R. Budman MD

Authors
  1. Mary Leung MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iulianna Shapira MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Bradley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel R. Budman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel R. Budman MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leung, M., Shapira, I., Bradley, T. et al. Adjuvant Chemotherapy for Early Breast Cancer in the Elderly. Curr. Treat. Options in Oncol. 10, 144–158 (2009). https://doi.org/10.1007/s11864-009-0092-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-009-0092-6

Keywords

Search

Navigation