TY - JOUR
T1 - Adjuvant trastuzumab in elderly with HER-2 positive breast cancer
T2 - A systematic review of randomized controlled trials
AU - Brollo, Janaina
AU - Curigliano, Giuseppe
AU - Disalvatore, Davide
AU - Marrone, Bianca Fontana
AU - Criscitiello, Carmen
AU - Bagnardi, Vincenzo
AU - Kneubil, Maximiliano Cassilha
AU - Fumagalli, Luca
AU - Locatelli, Marzia
AU - Manunta, Silvia
AU - Goldhirsch, Aron
PY - 2013/2
Y1 - 2013/2
N2 - 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.
AB - 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.
KW - Adjuvant treatment
KW - Breast cancer
KW - Elderly patients
KW - Geriatric oncology
KW - Systematic review
KW - Trastuzumab
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U2 - 10.1016/j.ctrv.2012.03.009
DO - 10.1016/j.ctrv.2012.03.009
M3 - Article
C2 - 22541668
AN - SCOPUS:84869092866
VL - 39
SP - 44
EP - 50
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
SN - 0305-7372
IS - 1
ER -