M.G. Sarobba, L. Pisanu, C. Porcu
Vol.3 (2018), issue 1, pag.24-34

Received 17/03/2018
Accepted for pubblication 22/03/2018
Published Mar. 2018
Review by Single-blind
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Age is the main risk factor for the onset of breast cancer. About 30% of the new diagnoses of breast cancer concern women over 70 years. In the last 20 years, an increase in incidence rates, and in survival occured. However, this does not apply to all patients: for younger people the annual mortality has been reduced by about 1.4% in elderly by 0.4%. Undertreatment, socio-economic differences and unequal access to treatment could be responsible in determining the worst prognosis. Few data are available regarding endocrine treatment of elderly patients, which are generally treated as younger patients in menopausal state, with Er-positive and Her-2 negative metastatic breast cancer. Aromatase inhibitors, have long been considered as one of the main first-line treatment options, based on the results of phase III studies showing their superiority, in terms of TTP and PFS, compared to tamoxifen. Recent studies have evaluated the use of aromatase inhibitors, compared to Fulvestrant 500 mg or to a combination of aromatase inhibitors and targeted agents, such as everolimus and, Cyclin-dependent kinase 4/6 (cdk4/6) inhibitors, palbociclib, ribociclib and abemaciclib, which have been shown to prolong PFS compared to aromatase inhibitors in both first and second line treatment. To date, the efficacy and safety data of the CDK4-6 inhibitors and of Everolimus in this setting are limited and mainly extrapolated from subgroup analyses of pivotal trials showing that PFS advantages are independent from age. For the toxicity profile, the incidence of adverse events was greater in elderly patients, as was the need to definitively interrupt treatment due to adverse events. However, interpreting these data, the small sample number must be taken into account, especially for over 70s, and should be considered that study population, although older, is not representative of the real population. Solid data from prospective studies would allow us to have an evidence-based approach in the management of elderly patients with HR + / HER2 negative breast cancer.