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Recommendation
Adjuvant endocrine therapy in older patients
Omission of adjuvant endocrine therapy is an option for older patients with a very low risk tumour (pT1aN0) or those with life-limiting comorbidities.
There is no age-dependent efficacy of tamoxifen or aromatase inhibitors. Efficacy is slightly greater with aromatase inhibitors; however, elderly patients are more vulnerable to toxicity and safety is important in choice of agent. Initial treatment should be tamoxifen or an aromatase inhibitor. Patients given tamoxifen should be considered for a switch to an aromatase inhibitor after 2–3 years. Extension of adjuvant treatment with an aromatase inhibitor after 5 years of tamoxifen could be considered for healthy elderly patients. Omission of endocrine therapy is an option for patients with a very low risk tumour (pT1aN0) or life-threatening comorbidities
How this guidance was developed
This recommendation was adapted from the SIOG/EUSOMA 2012 guidelines on the management of elderly patients with breast cancer (Europe). The source recommendation was based on a systematic review of the evidence conducted to June 2010 and was not graded by the source guideline authors. The source recommendation was simplified by removing the details of the treatment regimen and replacing ‘life-threatening comorbidities’ with ‘life-limiting comorbidities’.
Related guidance by topic
Adjuvant endocrine therapy in older patients
Recommendation
Omission of adjuvant endocrine therapy is an option for older patients with a very low risk tumour (pT1aN0) or those with life-limiting comorbidities.
Principles in action
Safe and quality care
This recommendation was adapted from the SIOG/EUSOMA 2012 guidelines on the management of elderly patients with breast cancer (Europe). The source recommendation was based on a systematic review of the evidence conducted to June 2010 and was not graded by the source guideline authors. The source recommendation was simplified by removing the details of the treatment regimen and replacing ‘life-threatening comorbidities’ with ‘life-limiting comorbidities’.
Related guidance by topic
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