For elderly women with good PS, when would you omit adjuvant anthracycline for early stage HR+,HER2- breast cancer with a high Oncotype Dx score?
I seldom recommend the use of an anthracycline in older patients with early stage HR+/HER- breast cancer, even when a high Oncotype score suggests that the patient would benefit from adjuvant chemotherapy. In the ABC combined analysis, patients with node negative HR+/HER2- cancers actually did worse...
I too avoid anthracyclines in older women. If she a good "functional age" rather chronical age I would use docetaxel and cyclophosphamide in preference to CMF. Although there has never been trial directly comparing TC versus CMF, the results indirect comparisons and network meta-analyses suggest tha...
I only use anthracyclines for young patients < 50 y/o with ER + but low and high ki-67 in addition to high Oncotype. I would recommend Taxotere/Cytoxan or CMF for elderly patient depending on her PS and other comorbidities.