Trastuzumab use in older patients with HER2-positive metastatic breast cancer: outcomes and treatment patterns in a whole-of-population Australian cohort (2003–2015)

Daniels, Benjamin; Kiely, Belinda E; Tang, Mónica; Tervonen, Hanna; Pearson, Sallie‐Anne

doi:10.1186/s12885-019-6126-y

Cited by 8 publications

(7 citation statements)

References 25 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The proportions of patients in our cohort 65 years and older (31%) and 75 years and older (11%) were notably larger than that reported from EMILIA. Older patients represent a growing proportion of patients treated with HER2-targeted agents [17] and recent Canadian real-world cohorts (of similar size to ours) from Ontario and Alberta reported median ages closer to our cohort (56 and 58 years, respectively [18,19]).…”

Section: Discussionsupporting

confidence: 76%

“…These differences in may be due to the older age of our population and the large proportion of our cohort receiving (neo)adjuvant trastuzumab therapy. Previous research, including our own, has shown shorter OS for patients 65 years and older [ 17 ], as well as worse outcomes in the metastatic setting associated with HER2-targeted therapy in patients previously treated with (neo)adjuvant trastuzumab [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trastuzumab emtansine for HER2-positive metastatic breast cancer: Outcomes from a whole-of-population Australian cohort

et al. 2021

Self Cite

View full text Add to dashboard Cite

We aim to describe the treatment patterns and overall survival (OS) outcomes in patients receiving trastuzumab emtansine (T-DM1) for HER2-positive metastatic breast cancer (HER2þMBC) in routine clinical care. Methods: Retrospective, whole-of-population cohort study of people initiating T-DM1 for HER2þMBC between October 2015 and May 2019 in Australia. We used dispensing claims to estimate time-to-T-DM1 initiation, duration of treatment, and treatments administered prior to and following T-DM1 therapy. We estimated OS from T-DM1 initiation and stratified results based on whether patients received firstor second-line T-DM1 treatment. We benchmarked outcomes to those reported in the pivotal, EMILIA trial. Results: 345 patients initiated T-DM1: 309 as second-line therapy for HER2þMBC and 36 as first-line therapy. 51% of patients had received endocrine therapy and 98% of second-line patients received pertuzumab prior to starting T-DM1. The median age was 57 years (53 in EMILIA); median time-to-T-DM1initiation from start of HER2-targeted therapy for HER2þMBC was 11.6 months (IQR: 7.9e16.6); median duration of T-DM1 treatment was 6.5 months (3.1e13.5; 7.6 months in EMILIA), and median OS was 19.3 months (7.9e29.5; 29.9 months in EMILIA). Conclusions: Our findings highlight differences in patient characteristics (older, more previous pertuzumab therapy) and outcomes (shorter OS) from the T-DM1 pivotal trial and provide real-world estimates that can inform patient, clinician and policy, decisions around the use of HER2-targeted therapies in routine clinical care.

show abstract

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Trastuzumab emtansine for HER2-positive metastatic breast cancer: Outcomes from a whole-of-population Australian cohort

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recently, there exists a controversy regarding whether women aged ≥ 80 years benefit from locoregional control as much as younger women, especially in patients that present with distant metastases. Additionally, another explanation might be that potential targeted therapy was associated with improved survival among patients aged < 65 years [28]. In fact, several retrospective studies have shown that the benefits and safety of optimal treatment were maintained in patients aged > 75 years [8].…”

Section: Discussionmentioning

confidence: 99%

Metastasis patterns and prognosis in breast cancer patients aged ≥ 80 years: a SEER database analysis

Han

Sui²,

Jia

et al. 2021

J. Cancer

View full text Add to dashboard Cite

Background: This study aimed to investigate the metastasis patterns and prognosis of breast cancer (BC) in patients aged ≥ 80 years with distant metastases, as the current literature lacks studies in this population. Methods: A retrospective, population-based study using data from the Surveillance, Epidemiology, and End Results (SEER) database was conducted to evaluate 36,203 patients with BC from 2010 to 2016. Patients were classified into three groups, the older group (aged ≥ 80 years), middle-aged group (aged 60-79 years), and younger group (aged < 60 years). The role of age at the time of BC diagnosis in metastasis patterns was investigated, and the survival of different age groups of patients with BC was assessed. Results: Overall, 4,359 (12%) patients were diagnosed with BC at age ≥ 80 years, 19,688 (54%) at 60-79 years, and 12,156 (34%) at < 60 years. Compared with the other two groups, those in the older group had a lower rate of treatment acceptance. Statistical analysis revealed that older patients were more likely to have lung invasion only (odds ratio [OR]: 1.274, 95% confidence interval [CI]: 1.163-2.674) and less likely to have bone invasion only (OR: 0.704, 95% CI: 0.583-0.851), brain invasion only (OR: 0.329, 95% CI: 0.153-0.706), or multiple metastatic sites (OR: 0.361, 95% CI: 0.284-0.458) compared to the other two groups. Age at diagnosis was an independent prognostic factor for survival. The older group had the worst overall survival (OS, P<0.001) and BC-specific survival (CSS, P<0.001). Furthermore, patients aged ≥ 80 years with only liver metastasis had the worst CSS and OS. Conclusion:Patients aged ≥ 80 years were less likely to be receptive to cancer-related therapy and had the highest cancer mortality rate among all patients. Our findings will hopefully help clinicians develop more appropriate modalities of cancer treatment in elderly BC patients.

show abstract

“…As a result of the ageing population, the number of elderly BC patients is rising. Despite this, elderly patients have been consistently underrepresented in clinical trials [7][8][9]. Only 16% of patients in the pivotal trials of adjuvant trastuzumab therapy were over 60 years old [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Set thresholds of chronological age, which de ne a patient as elderly, also vary from ≥ 65 [13,14], ≥ 70 [15][16][17] to ≥ 75 [5,18] or even ≥ 80 years old [19], which complicates comparisons between studies. Furthermore, older participants in randomised controlled trials (RTCs) may be tter than the wider elderly population [7][8][9]. Thus, the application of current treatment recommendations in elderly patients outside clinical trials can be limited due to the cardiotoxic nature of anthracycline-based chemotherapy and HER2-targeted therapy [8,9,[20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Adherence to multidisciplinary team meeting recommendations in elderly patients with HER2-positive breast cancer

Geissler

Maggi

Brülhart

et al. 2023

Preprint

View full text Add to dashboard Cite

Purpose Applying current treatment guidelines to elderly breast cancer (BC) patients is challenged by limited trial guidance, higher toxicities, and non-cancer related mortality. This study investigated adherence to multidisciplinary team meeting (MDTM) recommendations in elderly women with HER2 positive BC (HER2+BC) and its impacts on patient survival. Methods This retrospective multicentre cohort study collected data from 305 patients with primary diagnosis of HER2+BC. Women aged ≥65 years were classified into “concordant” or “discordant” groups according to MDTM recommendation adherence. Cox proportional hazards models and logistic regression analysis were used to assess the association between prognostic factors and patient outcomes. Results Of 305 HER2+BC patients, 111 (36%) were ≥65 years old. Of these, 55 (49.5%) and 53 (47.7%) were assigned to the concordant or discordant groups, respectively. The most frequent cause of MDTM discordance was treatment rejection by patients (57%). Median age (79 vs 70 years, p = <0.001) and Charlson Comorbidity Index (score 6 vs 5, p = 0.017) were significantly higher in the discordant group. After adjusting for age, UICC stage and hormone receptor status, overall survival (OS; HR 1.49, CI [0.64-3.46], p = 0.36) showed no significant difference between groups with a median follow up of 42.8 months. Patients with pre-existing cardiac diseases (29.6%) had significantly reduced OS (log-rank test p = 0.0082). Conclusion Adjustments to MDTMs for older BC patients may be necessary to increase patient treatment acceptance. Moreover, approaches to reduce treatment intensity in selected elderly patients with HER2+BC should be investigated further.

show abstract

Trastuzumab use in older patients with HER2-positive metastatic breast cancer: outcomes and treatment patterns in a whole-of-population Australian cohort (2003–2015)

Cited by 8 publications

References 25 publications

Trastuzumab emtansine for HER2-positive metastatic breast cancer: Outcomes from a whole-of-population Australian cohort

Trastuzumab emtansine for HER2-positive metastatic breast cancer: Outcomes from a whole-of-population Australian cohort

Metastasis patterns and prognosis in breast cancer patients aged ≥ 80 years: a SEER database analysis

Adherence to multidisciplinary team meeting recommendations in elderly patients with HER2-positive breast cancer

Contact Info

Product

Resources

About