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

Abstract Trastuzumab, in combination with chemotherapy, is the gold standard in the adjuvant treatment of patients with HER2 positive breast cancer. Limited data are available on the role of adjuvant trastuzumab in the elderly population. We performed a systematic review of prospective randomized tr...

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Bibliographic Details
Published in:Cancer treatment reviews 2013-02, Vol.39 (1), p.44-50
Main Authors: Brollo, Janaina, Curigliano, Giuseppe, Disalvatore, Davide, Marrone, Bianca Fontana, Criscitiello, Carmen, Bagnardi, Vincenzo, Kneubil, Maximiliano Cassilha, Fumagalli, Luca, Locatelli, Marzia, Manunta, Silvia, Goldhirsch, Aron
Format: Article
Language:English
Subjects:
Adjuvant treatment
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized - administration & dosage
Antineoplastic agents
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
Breast cancer
Breast Neoplasms - drug therapy
Breast Neoplasms - enzymology
Chemotherapy, Adjuvant
Elderly patients
Female
Geriatric oncology
Geriatrics - methods
Gynecology. Andrology. Obstetrics
Hematology, Oncology and Palliative Medicine
Humans
Mammary gland diseases
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Randomized Controlled Trials as Topic
Receptor, ErbB-2 - biosynthesis
Systematic review
Trastuzumab
Tumors
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Summary:Abstract Trastuzumab, in combination with chemotherapy, is the gold standard in the adjuvant treatment of patients with HER2 positive breast cancer. Limited data are available on the role of adjuvant trastuzumab in the elderly population. We performed a systematic review of prospective randomized trials with available data on the use of adjuvant trastuzumab in patients older than 60 years, focusing on both the efficacy and the cardiac safety. Data extrapolated from two prospective trials were included for efficacy and cardiac safety. A significant 47% relative risk reduction was observed in elderly patients receiving trastuzumab compared to chemotherapy alone (pooled Hazard Ratio: 0.53; 95% CI, 0.36–0.77). The pooled proportion of cardiac events in elderly patients treated with trastuzumab was 5% (95% CI, 4–7%). The use of trastuzumab should be considered as a standard of care in the adjuvant therapy of elderly patients with HER-2 positive breast cancer. Acute and chronic medical conditions, nutritional status and level of daily activities should be considered. Uncertainty about cardiac safety in the elderly is a major concern.
ISSN:0305-7372
1532-1967
DOI:10.1016/j.ctrv.2012.03.009