Pharmacotherapy for older adults with cancer: a digest of the Japanese clinical practice guidelines (second edition)-breast cancer.

BACKGROUND

The number of older adults with early breast cancer is rising in aging societies. Optimal perioperative systemic therapy for this population remains challenging, owing to heterogeneity in functional status, comorbidities, and the limited representation of older patients in clinical trials.

METHODS

This article presents an English digest of the Japanese Clinical Practice Guidelines for Pharmacotherapy in Older Adults with Cancer (Second Edition), focusing on perioperative systematic therapy for early breast cancer. The guidelines were developed in accordance with the Minds 2020 methodology, incorporating systematic reviews, the Evidence-to-Decision framework, and multidisciplinary consensus.

RESULTS

The guidelines address key clinical questions regarding perioperative systemic therapy for older patients with breast cancer, including human epidermal growth factor receptor 2 (HER2)-targeted therapy, immune checkpoint inhibitors, and treatment intensification strategies for hormone receptor-positive disease. Most recommendations are conditional because of limited direct evidence in older populations. Trastuzumab-based therapy remains the standard approach for HER2-positive disease, whereas alternative strategies may be considered for patients who are unable to tolerate chemotherapy. Immune checkpoint inhibitors combined with chemotherapy may improve recurrence-related outcomes in selected patients; however, evidence in older populations is limited. Additional therapies, such as abemaciclib or S-1, may reduce the risk of recurrence in high-risk patients but require careful consideration of toxicity.

CONCLUSIONS

These guidelines provide practical, evidence-based recommendations for perioperative systemic therapy in older adults with early breast cancer. They emphasize individualized treatment strategies that integrate patient characteristics, treatment goals, and tolerability. Further research specifically targeting older populations is needed to strengthen the evidence base for geriatric oncology.