The patients become elderly in different ways. Also known as physiological or functional age, biological age differs from chronological age and it considers not only the time elapsed, but also a number of different biological and physiological developmental factors, such as genetics, lifestyle, nutrition and comorbidities. Biological aging occurs as a person gradually accumulates damages to various cells. In addition, different cut-offs to enroll elderly patients are used.Ĭhronological age is the amount of time that has elapsed from birth to a given date and is the main way of defining age.
Scarce data are present on elderly patients, due to the mismatch between those who are most likely to get cancer (people ≥65 years) and those who are often enrolled in clinical trials (people <65 years). To define the AT in elderly patients, chronological age may be not enough. The individual benefit-risk balance of AT must take into account primarily the tumor characteristic such as hormone receptors, proliferation index, Scarff Bloom Richardson score, the nodal involvement and then the patient's fitness (e.g. Both the oncologic and geriatric risk factors affect the benefit-risk ratio of AT. One of the main issues is the lack of universal guidelines to determine the biological age to define a patient as old and which other factors need to be considered to define the most appropriate treatment. Then, which patient age (chronological or biological) has to be considered for the choice of the adjuvant treatment (AT) in BC? In the context of cancer, defining which age needs to be taken into account to drive the choice of treatment in elderly patients is important. The adjuvant therapeutic plan consists in hormonal therapy, chemotherapy, and radiotherapy if the risk of recurrence is high. The clinical practice for elderly patients with luminal tumor is surgery followed by adjuvant therapy (AT) in order to prevent recurrence. We agree with the authors with their final conclusions but we want to highlight that to define the adjuvant therapy in BC elderly patients more factors have to be taken into account. In their study on 12,004 elderly patients, they demonstrated that adjuvant chemotherapy was not associated with overall survival and due to the toxicities associated with systemic treatment caution recommendation or omission of chemotherapy may be considered in elderly patient selection especially in presence of co-morbidities. Ma and colleagues reported that elderly patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER-2) negative, node negative BC were underrepresented in prior prospective trials. Elderly women tend to have less aggressive tumors (Luminal-A like) than other age groups. Moreover, the multidisciplinary team for the elderly patient evaluation should include both the geriatrician and the molecular biologist.īreast cancer (BC) patients aged over 65 represent 47%, and this percentage will increase over the next 20 years ( ). For these reasons, beyond comorbidities, the choice of adjuvant therapy for elderly patients must also be based both on chronological and biological age. In clinical practice it can be very difficult to estimate the benefit/risk ratio in elderly patients because chemotherapy-induced toxicity is worse than in younger individuals. One of the main issues is the lack of universal and unique guidelines to define elderly patients. We agree with authors final conclusions but we want to highlight that to define the adjuvant therapy in BC elderly patients several factors need to be taken into account. Given the toxicities associated with systemic treatments, caution recommendation or omission of chemotherapy may be considered in elderly patient selection especially when comorbidities are present. 2020, that adjuvant chemotherapy was not associated with overall survival. Ma and colleagues reported in their study on 12,004 elderly patients published on Breast J.
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