State of the art therapy for elderly patients with early-stage and locally advanced breast cancer

The global incidence of cancer is expected to increase dramatically in the coming years, due in part to ageing populations. Historically, elderly women with breast cancer have been excluded from clinical trials, making it difficult to develop evidence-based treatment guidelines. Ageing is a highly individualised process and age alone should not be used to deny treatment to otherwise appropriate patients. Comprehensive geriatric assessment (CGA), routinely used by geriatricians, is becoming increasingly relevant to oncology practice. CGA may have a direct effect on treatment decisions in breast cancer. While the role of adjuvant radiotherapy remains debated, surgery remains the best option for fit older patients. Data support the use of adjuvant tamoxifen for hormone receptor-positive disease, and the additional benefit of aromatase inhibitors remains to be fully determined. The benefits of adjuvant polychemotherapy, capecitabine or pegylated liposomal doxorubicin monotherapy are under evaluation in on-going phase III trials.