Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: A systematic review of randomized controlled trials

A considerable number of breast cancer diagnoses are made in older women. Differing physiological needs of older patients and biology of tumors compared with younger patients may alter treatment options between surgery and nonsurgical primary approaches. Adjuvant therapies may benefit these patients; however, concerns about toxicity and physical demands of treatment may affect patient choice regarding treatment. Furthermore, quality of life may be more important to the older individual than curative treatment alone. Growing evidence is emerging for employing Comprehensive Geriatric Assessment to determine other factors that may contribute to treatment decision-making in the older population. The way geriatric oncology is delivered varies, bringing the importance of the multidisciplinary team to the forefront of care delivery in this age group. Future research in this area should include combined consideration of tumor biology and geriatric needs.

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“…This analysis showed a 47% relative risk reduction in those patients receiving trastuzumab, with a small (5%) risk of cardiac events [67].…”

Section: Trastuzumabmentioning

confidence: 94%

Management of Operable Primary Breast Cancer in Older Women

Syed

Parks

Cheung

2014

Womens Health (Lond Engl)

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“…A recent paper published by Brollo et al [34 ]analyzed the role of trastuzumab in elderly patients in an adjuvant setting. However, these data can not be compared with our results because this work included patients >60 years old whereas we refer to a population of >70 years old.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Toxicities from Trastuzumab, Alone or in Combination, in an Elderly Breast Cancer Population

et al. 2013

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Background: Breast cancer in the elderly is associated with high recurrence and death rates, due mostly to undertreatment. Human epidermal growth factor receptor type 2 (HER2) overexpression is infrequent in older patients. Trastuzumab-based chemotherapy is often withheld from elderly patients because of its cardiotoxicity. Patients and Methods: Medical records of consecutive HER2-positive breast cancer patients aged ≥70 years old treated between 2005 and 2010 in the participating centers were retrospectively reviewed. All patients underwent multidimensional geriatric assessment (MGA). Results: Among 59 patients identified, 51 patients were evaluable (median age 76 years). The rate of any adverse event was 20% (10/51). The most relevant cardiac adverse event consisted of symptomatic congestive heart failure (CHF; n = 1, 2%) followed by asymptomatic decreases of left ventricular ejection fraction (LVEF; n = 6, 12%). Other toxicities included moderate hypersensitivity reactions during trastuzumab infusions (n = 3, 6%). Hypertension, obesity, prior anthracyclines exposure and concurrent chemotherapy were associated with a higher incidence of toxic events. Previous radiotherapy, concurrent endocrine therapy and different trastuzumab-based regimens did not seem to influence toxicity. Conclusions: Our data suggest that trastuzumab has a good safety profile in nonfrail women aged 70 years and older. These favorable findings may be related to a limited number of anthracycline pretreatments, patient selection and a close cardiologic monitoring.

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“…Data of patients older than 60 years were represented in the HERA, NSABP 31, and N9831 trials. A systemic review showed that adjuvant trastuzumab caused a 47% relative risk (RR) reduction in the DFS events in elderly patients [17]. In this study, 4.9% of all patients were older than 70 years, and this patient group had worse RFS than younger patients (table 2).…”

Section: Discussionmentioning

confidence: 91%

Prognostic Factors for Recurrence-Free Survival in Patients with HER2-Positive Early-Stage Breast Cancer Treated with Adjuvant Trastuzumab

et al. 2013

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Background: The objective of this study was to identify prognostic factors affecting the recurrence-free survival (RFS) in patients who received a 52-week trastuzumab therapy for HER2-positive early stage breast cancer (EBC). Patients and Methods: The medical records of all patients with EBC from 10 centers were analyzed. Pathologic and clinical tumor characteristics were evaluated in 424 female patients who received 52 weeks of adjuvant trastuzumab for HER2-positive EBC. Survival was estimated using the Kaplan-Meier method. Univariate analyses of RFS were performed with the log-rank test. Independent prognostic and predictive factors affecting RFS were assessed by Cox regression analysis. Results: Median follow-up time was 33.1 months (range 9.2-75.9 months). 3-year RFS and overall survival were 87 and 97%, respectively. In multivariate analysis, patients aged 70 years or over (p = 0.017, relative risk (RR) 2.7, 95% confidence interval (CI) 1.19-6.13), patients with > 9 positive lymph nodes (p = 0.001, RR 2.52, 95% CI 1.42-4.46), and those with progesterone receptor-negative tumors (p = 0.006, RR 2.33, 95% CI 1.27-4.27) had worse RFS. Conclusion: In spite of a 52-week adjuvant trastuzumab treatment, classic poor prognostic factors for invasive EBC remained as such in patients with HER2-positive EBC.

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Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: A systematic review of randomized controlled trials

Cited by 71 publications

References 38 publications

Management of Operable Primary Breast Cancer in Older Women

Management of Operable Primary Breast Cancer in Older Women

The Risk of Toxicities from Trastuzumab, Alone or in Combination, in an Elderly Breast Cancer Population

Prognostic Factors for Recurrence-Free Survival in Patients with HER2-Positive Early-Stage Breast Cancer Treated with Adjuvant Trastuzumab

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