진행성 노인 유방암에 대한 항암요법

Systemic Treatment of Older Patients with Advanced Breast Cancer

유방암이 생물학적으로 매우 다양한 질환의 집합이듯이 노인 유방암 환자 역시 다양한 생리적 예비능력과 생리적 나이를 가진 다양한 집단이다. 노인 유방암 환자의 접근에 있어 질병의 생물학적 특징 못지않게 환자의 생리적 기능, 인지 기능, 기동성, 동반 질환 등 환자의 다양한 요소를 포괄적으로 평가하여 맞춤 치료를 실현하여야 할 것이다.

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-representation of such individuals in clinical trials. Although older patients have more indolent disease with more Hormone Receptor positive disease 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 advanced breast cancer should be treated based on their biological tumor type, according to the patient's general health and preferences: endocrine treatment for HR-positive disease; Human Epidermal Growth Factor Receptor 2-targeted agent with chemotherapy, endocrine therapy or HER2-targeted agent alone for HER2 positive disease. Chemotherapy should be considered for patients who are HR-negative, HR-positive but refractory to endocrine treatment, or with a rapidly progressing visceral crisis. Generally, sequential chemotherapy with a single agent is recommended over combination chemotherapy, and agents with known toxicities in older patients are recommended, including weekly taxane, vinorelbine, capecitabine, and liposomal doxorubicin. Some form of geriatric assessment should be performed for older patients to assess the patients' biological age, functional status, and address age-specific problems, leading to early interventions. The goal of therapy should be individualized to maintain the quality of life, function, and independence of older patients with cancer.