THE ROLE OF CHEMOTHERAPY AND ADJUVANT THERAPY IN THE MANAGEMENT OF BREAST-CANCER IN OLDER WOMEN

The management of breast cancer in older women is a major challenge. A metaanalysis of randomized trials of adjuvant therapy in early stage breast cancer has indicated that the use of the antiestrogen tamoxifen improves relapse-free and overall survival for postmenopausal women, including those older than age 70 years. Tamoxifen therapy is of great est benefit in patients whose primary lesions are estrogen- and proges terone-receptor positive, but lesser yet still significant benefits ar e seen in receptor-negative patients. Adjuvant chemotherapy has only b een minimally studied in older women, because earlier trials tended to exclude women older than age 70 years from protocol entry. Trials are needed to explore the role of adjuvant chemotherapy in older women, e specially those older than age 70 years. Metastatic breast cancer is i ncurable. Standard endocrine and chemotherapy regimens may be of great palliative benefit but probably only have modest effects on prolongin g survival; older women should be offered such treatment. Initiating t reatment for metastases with endocrine therapy does not compromise sur vival, even when such therapy is given to women who have receptor-nega tive malignancy. Patients progressing on endocrine therapy or whose me tastatic disease is life-threatening should be considered for chemothe rapy. Older women in generally good health tolerate standard doses of chemotherapy as well as their younger counterparts. Future research in this setting should include clinical trials designed specifically for the elderly and should include quality-of-life assessment as a major end point.