Trastuzumab in small tumours and in elderly women

Trastuzumab in the treatment of elderly patients with early breast cancer: Results from an observational study in Germany

“…4,5 The lack of data in elderly patients with breast cancer results from the trend to exclude older and/or comorbid patients from randomized phase III trials, especially those focusing on newly developed treatments. [4][5][6][7][8] Therefore, recommendations, such as those compiled by the International Society of Geriatric Oncology (SIOG) mostly have to rely on the extrapolation of data from younger patients, with respect to efficacy, and to toxicity-driven contraindications, precautions, or usage restrictions. 4 In elderly patients, the introduction and consecutive improvement of adjuvant chemotherapy seems to have a smaller impact on outcome, especially on mortality.…”

“…[18][19][20] However, because the number of elderly patients in these large trials was rather small, treatment guidelines are less well established in this population. 6,21 In fact, the incidence of HER2-positivity in elderly patients is still not well described, 3,6,10 although the National Comprehensive Cancer Network (NCCN) recently reported 26% of patients with HER2-positive, early breast cancer to be 60 years or older. 22 Current estimates indicate that the proportion of HER2-positive cases among elderly patients with breast cancer is 10% to 20%, which is not much different from the incidences reported for the entire breast cancer population.…”

Would 1.0 cm be a more suitable cutoff to subdivide pT1 tumors in hormone receptor‐negative and HER2‐positive breast cancer?

“…Due to the wide use of screening mammography, there was an increasing trend for pT1a‐pT1b breast cancer (up to 20% of newly diagnosed breast cancer) . Despite the dramatic effect of anti‐HER2 agents, no available randomized clinical trials examined the efficacy of adjuvant trastuzumab in pT1a, b HER2+ breast cancers . Besides, the existing retrospective studies reached conflicting results regarding the prognosis of HER2+ T1a, b tumors.…”

“…7,8 Despite the dramatic effect of anti-HER2 agents, no available randomized clinical trials examined the efficacy of adjuvant trastuzumab in pT1a, b HER2+ breast cancers. 9,10 Besides, the existing retrospective studies reached conflicting results regarding the prognosis of HER2+ T1a, b tumors. The Finnish cancer registry study suggested that pT1a, b N0M0 patients had an excellent prognosis with distant disease-free survival reached up to 100%.…”

Adjuvant regimens with trastuzumab administered for small HER2-positive breast cancer in routine clinical practice

“…Even though small breast tumors have usually been considered to be low risk, their prognosis worsens when they overexpress the HER2/neu gene. In fact, HER2 overexpression has shown to represent a powerful adverse prognostic factor for patients with tumors even smaller than 1-2 cm [4,5].…”