진행성 노인 유방암에 대한 항암요법 (Systemic Treatment of Older Patients with Advanced Breast Cancer)

서지정보

· 발행기관 : 대한내과학회
· 수록지 정보 : 대한내과학회지 / 87권 / 5호 / 542 ~ 547페이지
· 저자명 : 여경아, 김지현

초록

Due to its increasing incidence and longer life expectancy, more patients are being diagnosed with breast cancer at older ages.
There are very limited data on the optimum management of older patients with advanced breast cancer, due to the under-representationof such individuals in clinical trials. Although older patients have more indolent disease with more Hormone Receptor positivedisease and less HER2-positive disease, their disease-specific mortality remains lower than in younger patients, owing to the late diagnosis,under treatment due to age bias, reduced access to healthcare, and socioeconomic issues. Older patients with advancedbreast cancer should be treated based on their biological tumor type, according to the patient’s general health and preferences: endocrinetreatment for HR-positive disease; Human Epidermal Growth Factor Receptor 2-targeted agent with chemotherapy, endocrinetherapy or HER2-targeted agent alone for HER2 positive disease. Chemotherapy should be considered for patients who areHR-negative, HR-positive but refractory to endocrine treatment, or with a rapidly progressing visceral crisis. Generally, sequentialchemotherapy with a single agent is recommended over combination chemotherapy, and agents with known toxicities in older patientsare recommended, including weekly taxane, vinorelbine, capecitabine, and liposomal doxorubicin. Some form of geriatric assessmentshould be performed for older patients to assess the patients’ biological age, functional status, and address age-specificproblems, leading to early interventions. The goal of therapy should be individualized to maintain the quality of life, function, andindependence of older patients with cancer.

영어초록

Due to its increasing incidence and longer life expectancy, more patients are being diagnosed with breast cancer at older ages.
There are very limited data on the optimum management of older patients with advanced breast cancer, due to the under-representationof such individuals in clinical trials. Although older patients have more indolent disease with more Hormone Receptor positivedisease and less HER2-positive disease, their disease-specific mortality remains lower than in younger patients, owing to the late diagnosis,under treatment due to age bias, reduced access to healthcare, and socioeconomic issues. Older patients with advancedbreast cancer should be treated based on their biological tumor type, according to the patient’s general health and preferences: endocrinetreatment for HR-positive disease; Human Epidermal Growth Factor Receptor 2-targeted agent with chemotherapy, endocrinetherapy or HER2-targeted agent alone for HER2 positive disease. Chemotherapy should be considered for patients who areHR-negative, HR-positive but refractory to endocrine treatment, or with a rapidly progressing visceral crisis. Generally, sequentialchemotherapy with a single agent is recommended over combination chemotherapy, and agents with known toxicities in older patientsare recommended, including weekly taxane, vinorelbine, capecitabine, and liposomal doxorubicin. Some form of geriatric assessmentshould be performed for older patients to assess the patients’ biological age, functional status, and address age-specificproblems, leading to early interventions. The goal of therapy should be individualized to maintain the quality of life, function, andindependence of older patients with cancer.

참고자료

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