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Use of taxanes in the older cancer patients task force

Taxanes in breast cancer: have we better defined their role in older patients?
Balancing efficacy against toxicity is especially difficult in the elderly who have diminished physiological reserves and significant comorbidities. The problem is compounded by the under-representation of such patients in trials and a consequent lack of evidence on optimum drug, dose and schedule. In the adjuvant setting, taxane toxicity is greater in older than in younger patients, but taxanes can be added to anthracylines in healthy high-risk patients or can be used instead of them to reduce cardiac risk. In HER2-positive patients, paclitaxel or docetaxel plus cyclophosphamide is an alternative to anthracylines and reduces trastuzumab-related cardiotoxicity. In metastatic disease, weekly paclitaxel or three-weekly docetaxel are cornerstones of treatment. Nab-paclitaxel offers efficacy comparable to solvent-based taxanes but has been little studied in the elderly.

Aims

  • To define groups of elderly patients who benefit of taxanes, taking into account typical underlying diseases of the elderly population.
  • To critically revise the most recent literature on order to identify treatment options with taxanes by considering effectiveness and tolerance in elderly patients.
  • To specifically define benefits of the use of taxanes with the goal of reducing possible complications.
  • Define decision aids accounting for the latest evidence of taxanes’ use and rules for evaluation of life expectancy, and competing morbidity/mortality in the elderly.
  • Give recommendations and propose decision paradigms for assisting clinicians in choosing the appropriate treatments.

Task Force Members

Chairs: Matti Aapro, Switzerland & Laura Biganzoli, Italy

Writing Committee
Etienne Brain, France
Sibylle Loibl, Germany
Hans Wildiers, Belgium

Revieving Committee
Jonas Bergh, Sweden
Evandro de Azambuja, Belgium
Miguel Martin, Spain
Alessandro Minisini, Italy
Gilbert Zulian, Switzerland
Martine Extermann, USA

Publication

2016
Taxanes in the treatment of breast cancer: Have we better defined their role in older patients? A position paper from a SIOG Task Force L. Biganzoli, M. Aapro, Sibylle Loibl, Hans Wildiers, Etienne Brain. Cancer Treatment Reviews February 2016 Volume 43, Pages 19–26

This project was supported by an unrestricted grant from Celgene.