Safety of adjuvant trastuzumab for HER-2-overexpressing elderly breast cancer patients: a multicenter cohort study

• Published in: Breast cancer (Tokyo, Japan) Japan), 2012-07, Vol.19 (3), p.253-258
• Main Authors: Sawaki, Masataka, Mukai, Hirofumi, Tokudome, Nahomi, Nakayama, Takahiro, Taira, Naruto, Mizuno, Toshiro, Yamamoto, Yutaka, Horio, Akiyo, Watanabe, Toru, Uemura, Yukari, Ohashi, Yasuo
• Format: Article
• Language: English
• Subjects: Aged; Aged patients; Aged, 80 and over; Analysis; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Antimitotic agents; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - metabolism; Breast Neoplasms - mortality; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer; Cancer patients; Cancer Research; Care and treatment; Chemotherapy; Chemotherapy, Adjuvant; Cohort Studies; Complications and side effects; Cyclophosphamide; Diuretics; Doxorubicin; Female; Fluorouracil; Follow-Up Studies; Heart Failure - chemically induced; Humans; Medicine; Medicine & Public Health; Natriuretic Peptide, Brain - metabolism; Natriuretic peptides; Oncology; Oncology, Experimental; Original Article; Receptor, ErbB-2 - metabolism; Retrospective Studies; Safety and security measures; Surgery; Surgical Oncology; Time Factors; Trastuzumab; Treatment Outcome; Ventricular Dysfunction, Left - chemically induced
• ISSN: 1340-6868; 1880-4233
• DOI: 10.1007/s12282-011-0270-9

Background For targeting anti-HER-2, trastuzumab-incorporated chemotherapy is the standard for HER-2-overexpressing breast cancer in adjuvant settings. But there are few data on trastuzumab in elderly patients. We evaluated the incidence of adverse events among an elderly population of trastuzumab-treated HER-2-positive breast cancer patients in adjuvant settings. Methods Data on 39 elderly HER-2 overexpressing breast cancer patients treated with both curative surgery and adjuvant trastuzumab were retrospectively collected from a Japanese multicenter study. The loading dose was 8 mg/kg body weight, and the maintenance dose was 6 mg/kg every 3 weeks; or the loading dose was 4 mg/kg followed by 2 mg/kg weekly as maintenance. Results After a median follow-up of 20.0 (2.4–53.9) months, a total of 32 patients (82.1%) completed 1-year trastuzumab treatment. The median treatment duration was 12.0 months (range 2–12; mean 10.5). Adverse events occurred in 11 patients (28.2%). Four (10.2%) discontinued or interrupted treatment after experiencing toxicity. One patient died because of interstitial pneumonia. Three patients (7.7%) had congestive heart failure (CHF), one of whom had a history of angina. Three patients (7.7%) had a lower left ventricular ejection fraction (LVEF), and brain natriuretic peptide elevation was totally observed in three patients (7.7%). Three patients with lower LVEF had received chemotherapy containing doxorubicin before trastuzumab. Of the three patients, two discontinued therapy because of CHF, but all recovered with proper medication containing a diuretic agent. Conclusions Elderly patients tolerated trastuzumab well, although careful management is needed.