Adjuvant Chemotherapy and Trastuzumab Is Safe and Effective in Older Women With Small, Node-Negative, HER2-Positive Early-Stage Breast Cancer

Abstract

The benefit of adjuvant trastuzumab with chemotherapy in breast cancer is well-established; however, its impact on outcomes for older women with small, node-negative, human epidermal growth factor receptor 2-positive disease is less clear and unlikely to be addressed in prospective studies. This retrospective, sequential cohort study suggests adjuvant trastuzumab with chemotherapy results in excellent breast cancer outcomes with few cardiac events in this population. Introduction The benefit of adjuvant trastuzumab with chemotherapy is well established for women with higher risk human epidermal growth factor receptor 2-positive (HER2+) breast cancer. However, its role in older patients with smaller, node-negative tumors is less clear. We conducted a retrospective, sequential cohort study of this population to describe the impact of trastuzumab on breast cancer outcomes and cardiac safety. Patients and Methods Women ≤ 55 years with ≥ 2 cm, node-negative, HER2+ breast cancer were identified and electronic medical records reviewed. A no-trastuzumab cohort of 116 women diagnosed between January 1, 1999 and May 14, 2004 and a trastuzumab cohort of 128 women diagnosed between May 16, 2006 and December 31, 2010 were identified. Overall survival and distant relapse-free survival were estimated by Kaplan-Meier methods. Results The median ages of the trastuzumab and no-trastuzumab cohorts were 62 and 64 years, respectively. More patients in the trastuzumab cohort had grade III (P = .001), lymphovascular invasion (P = .001), or estrogen receptor-negative (P < .001) cancers. The majority of the trastuzumab cohort received chemotherapy versus one-half of the no-trastuzumab cohort (98% vs. 53%; P < .0001). The median follow-up was 4 versus 9 years in the trastuzumab versus no-trastuzumab cohorts; therefore, outcomes at 4 years are reported. Despite the higher-risk tumor features in the trastuzumab group, the 4-year overall survival was 99% in both cohorts; the distant relapse-free survival was 99% versus 97% in the trastuzumab versus no-trastuzumab cohorts. Four (3.1 %; 95% confidence interval, 1.0%–7.8%) women in the trastuzumab cohort and 1 in the no-trastuzumab cohort developed symptomatic heart failure. There were no cardiac-related deaths in either arm. Conclusion Following adjuvant trastuzumab with chemotherapy, selected older women with small, node-negative, HER2+ breast cancers have excellent disease control. The rate of cardiac events is low.

Long-term outcomes and prognostic factors in elderly patients with breast cancer: single-institutional experience

“…A recent study from India showed a substantial increase of HER2-targeted therapy among patients treated at a public hospital in the past decade, likely due to the advent of biosimilars, the use of shorter duration adjuvant regimens [ 21 ]. Another study by Cadoo et al [ 22 ] has shown the efficacy of adjuvant chemotherapy and trastuzumab in elderly patients. However, the patient cohort in this study was age >55 years and <25% of the patients were above 70 years of age.…”

Caracterización clínica y terapéutica del cáncer de mama, en mujeres mayores, atendidas en un centro oncológico de Medellín – Colombia

“…La terapia antiHER2 se ha asociado además con toxicidad cardiaca, sin embargo la frecuencia de esta puede variar [31]. Un estudio hecho en pacientes mayores, muestra que la adición de trastuzumab a la quimioterapia adyuvante, se puede relacionar con una baja incidencia de eventos cardiacos, una supervivencia general a 4 años del 99% y una supervivencia libre de recaídas a distancia del 99% [32]. Entre nuestras pacientes no se reportó suspensión de la terapia debido a efectos cardiotóxicos del trastuzumab.…”

Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer

“…Nevertheless, the results of this meta-analysis may have contributed to the lower use of adjuvant chemotherapy in older BC patients [35]. Other recent studies suggest a possible benefit from adjuvant chemotherapy in older BC patients, especially in those with HER2-positive disease [37,38]. Recently, Du et al compared the effectiveness of adjuvant chemotherapy between older BC and CRC patients, and found that chemotherapy might be effective in BC patients up to the age of 79 years [39].…”