Breast Cancer
The task force undertook a review of the literature about breast cancer covering the last 18 years in order to issue recommendations for the treatment of elderly breast cancer patients on the topics of screening, surgery, radiotherapy, (neo)adjuvant hormone treatment and chemotherapy, as well as metastatic disease.
HER2-targeted treatment for older patients with breast cancer
During the past decade, HER2+ breast cancer patients have greatly benefited from the development of specific treatments targeting the HER2 receptor (monoclonal antibodies, tyrosine kinase inhibitors TKI, conjugates, etc.): the pioneer trastuzumab followed shortly by the tyrosine kinase inhibitor lapatinib, and the recently launched trastuzumab-emtansine best exemplify this move.
There are different processes related to aging which imply specifying monitoring of these treatments in the elderly patients, when given either alone, in combination according to the concept of multi-HER2 blockade, or in association with endocrine or cytotoxic agents. Stakes and issues may differ compared with younger patients. The Task Force will evaluate these questions and give expert position paper adapted for various types of anti-HER2 agents currently available or in development.
End Points and Trial Design in Geriatric Oncology Research: A Joint European Organization for Research and Treatment of Cancer–Alliance for Clinical Trials in Oncology–International Society of Geriatric Oncology (Position Article) Hans Wildiers, Murielle Mauer, Athanasios Pallis, Arti Hurria, Supriya G. Mohile, Andrea Luciani, Giuseppe Curigliano, Martine Extermann, Stuart M. Lichtman, Karla Ballman, Harvey Jay Cohen, Hyman Muss, and Ulrich Wedding J Clin Oncol 31. © 2013 by American Society of Clinical Oncology Published Ahead of Print on September 9, 2013 as 10.1200/JCO.2013.49.6125
To review the available evidence showing that anti-HER2 treatments administration in HER2+ breast cancer can be administered safely to older patients with the same level of benefits as in younger patients.
Chairs
Etienne Brain, France & Hans Wildiers, Belgium
Writing Committee
Laura Biganzoli, Italy
Philippe Caillet, France
Karis Cheng, Singapore
Lissandra Dal Lago, Belgium
Nienke de Glas, the Netherlands
2019
HER2-targeted treatment for older patients with breast cancer: An expert position paper from the International Society of Geriatric Oncology. Brain E, Caillet P, de Glas N, Biganzoli L, Cheng K, Lago LD, Wildiers H. J Geriatr Oncol. 2019 Jun 21. pii: S1879-4068(18)30479-X. doi: 10.1016/j.jgo.2019.06.004.
This project was supported by an unrestricted grant from Roche. 
CDK4/6 inhibitors in elderly breast cancer patients
The current standard of care for the management of estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer has been redefined by the introduction of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. Although adults aged 65 years and older account for the majority of patients with breast cancer, limited data are available about the age-specific dosing, tolerability, and benefit of CDK4/6 inhibitors in this growing population.
Taxanes in the treatment of breast cancer in elderly patients
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.
- 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.
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
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. 
