Practice management for elderly patients with breast cancer; Findings from a survey by the Japan Breast Cancer Study Group

Information on patterns of clinical care for elderly breast cancer patients is lacking. The aims of this study are two-fold, firstly, to clarify daily practice treatments for elderly breast cancer patients in Japan, and secondly, to plan a prospective clinical trial to address unresolved clinical questions. We investigated practice care of elderly breast cancer patients in 38 institutions of the Japan Clinical Oncology Group (JCOG). Questionnaires asked: (1) definition of “elderly” for each treatment, (2) clinical standard anti-HER2 therapy in each age-group, (3) recommended docetaxel dose in each age-group, (4) considerations for future clinical trials, and (5) other information about geriatric oncology concerning breast cancer. The upper age-limit for surgery and irradiation therapy was generally 80 years, while many physicians considered anti-cytotoxic adjuvant therapy unsuitable for patients >70–75 years. For HER2-positive metastatic breast cancer, 82% of physicians recommended docetaxel (DTX) plus trastuzumab plus pertuzumab (DTP) as standard care for patients aged 65–70, although 54% of physicians avoided DTP for those aged 71–75 as first-line standard preference. Most physicians recommended 75 mg/m(2) DTX for both 65–70 (63%) and 70–75 (52%) age-groups, but not for those over 75. Many physicians (73%) recommended 60 mg/m(2) DTX first. Most (97%) agree that the vulnerability of each elderly patient in a clinical trial should be assessed by comprehensive geriatric assessment. This is the first questionnaire study of care patterns for elderly breast cancer patients. Physicians considered different drug regimens and dosages according to patients’ fragility.