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

Janaina Brollo, Giuseppe Curigliano, Davide Disalvatore, Bianca Fontana Marrone, Carmen Criscitiello, Vincenzo Bagnardi, Maximiliano Cassilha Kneubil, Luca Fumagalli, Marzia Locatelli, Silvia Manunta, Aron Goldhirsch

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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.

Original languageEnglish
Pages (from-to)44-50
Number of pages7
JournalCancer Treatment Reviews
Issue number1
Publication statusPublished - Feb 2013


  • Adjuvant treatment
  • Breast cancer
  • Elderly patients
  • Geriatric oncology
  • Systematic review
  • Trastuzumab

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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