Adjuvant Chemotherapy and HER-2-directed Therapy for Early-stage Breast Cancer in the Elderly

Overview

Journal Br J Cancer

Specialty Oncology

Date 2016 Nov 23

PMID 27875517

Citations 9

Authors

J Sun

S Chia

Affiliations

Soon will be listed here.

Abstract

There is a lack of sufficient evidence-based data defining the optimal adjuvant systemic therapies in older women. Recommendations are mainly based on retrospective studies, subgroup analyses within larger randomised trials and expert opinion. Treatment decisions should consider the functional fitness of the patient, co-morbidities, in addition to chronological age with the aim to balance risks and potential benefits from treatment(s). In this review, we discuss assessment tools to aid clinicians to select elderly patients who are 'fit' for chemotherapy, and review the literature on the use of chemotherapy and of the anti-HER 2 antibody trastuzumab in this population. We will also review two commonly used prediction models to assess their accuracy in predicting survival outcomes in elderly patients. Ongoing clinical trials specifically focusing on older patients may help to clarify the absolute benefits and risks of adjuvant systemic therapy in this age group.

Citing Articles

Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment.

Houvenaeghel G, Cohen M, Goncalves A, Berthelot A, Chauvet M, Faure C Front Oncol. 2024; 13:1287253.

PMID: 38162480 PMC: 10757327. DOI: 10.3389/fonc.2023.1287253.

Long-term follow-up of early stage HER2-positive breast cancer patients treated with trastuzumab: A population-based real world multicenter cohort study.

Ellegard S, Engvall K, Asowed M, Hallbeck A, Elander N, Stal O Front Oncol. 2022; 12:861324.

PMID: 35982977 PMC: 9379250. DOI: 10.3389/fonc.2022.861324.

Adjuvant Treatment of Elderly Breast Cancer Patients: Offer the Best Chances of Cure.

Marinopoulos S, Dimitrakakis C, Kalampalikis A, Zagouri F, Andrikopoulou A, Rodolakis A Breast Care (Basel). 2022; 17(1):71-80.

PMID: 35355693 PMC: 8914240. DOI: 10.1159/000513708.

Is adjuvant chemotherapy necessary in older patients with breast cancer?.

Morita M, Shimomura A, Tokuda E, Horimoto Y, Kawamura Y, Ishizuka Y Breast Cancer. 2022; 29(3):498-506.

PMID: 35032302 PMC: 9021076. DOI: 10.1007/s12282-021-01329-7.

identified as a potential breast cancer marker: evidence from bioinformatics analysis and basic experiments.

Mo L, Liu J, Yang Z, Gong X, Meng F, Zou R Gland Surg. 2021; 9(6):1955-1972.

PMID: 33447546 PMC: 7804547. DOI: 10.21037/gs-20-431.

References

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M . Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014; 136(5):E359-86. DOI: 10.1002/ijc.29210. View

Coates A, Winer E, Goldhirsch A, Gelber R, Gnant M, Piccart-Gebhart M . Tailoring therapies--improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol. 2015; 26(8):1533-46. PMC: 4511219. DOI: 10.1093/annonc/mdv221. View

Brollo J, Curigliano G, Disalvatore D, Marrone B, Criscitiello C, Bagnardi V . Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: a systematic review of randomized controlled trials. Cancer Treat Rev. 2012; 39(1):44-50. DOI: 10.1016/j.ctrv.2012.03.009. View

Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I . Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012; 13(4):e148-60. DOI: 10.1016/S1470-2045(11)70383-7. View

Wishart G, Azzato E, Greenberg D, Rashbass J, Kearins O, Lawrence G . PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer. Breast Cancer Res. 2010; 12(1):R1. PMC: 2880419. DOI: 10.1186/bcr2464. View

Punglia R, Hughes K, Muss H . Management of older women with early-stage breast cancer. Am Soc Clin Oncol Educ Book. 2015; :48-55. DOI: 10.14694/EdBook_AM.2015.35.48. View

Aapro M, Bernard-Marty C, Brain E, Batist G, Erdkamp F, Krzemieniecki K . Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper. Ann Oncol. 2010; 22(2):257-67. DOI: 10.1093/annonc/mdq609. View

Piccart-Gebhart M, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I . Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005; 353(16):1659-72. DOI: 10.1056/NEJMoa052306. View

Soubeyran P, Bellera C, Goyard J, Heitz D, Cure H, Rousselot H . Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One. 2014; 9(12):e115060. PMC: 4263738. DOI: 10.1371/journal.pone.0115060. View

10.

Pallis A, Fortpied C, Wedding U, Van Nes M, Penninckx B, Ring A . EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer. 2010; 46(9):1502-13. DOI: 10.1016/j.ejca.2010.02.022. View

11.

von Minckwitz G, Conrad B, Reimer T, Decker T, Eidtmann H, Eiermann W . A randomized phase 2 study comparing EC or CMF versus nab-paclitaxel plus capecitabine as adjuvant chemotherapy for nonfrail elderly patients with moderate to high-risk early breast cancer (ICE II-GBG 52). Cancer. 2015; 121(20):3639-48. DOI: 10.1002/cncr.29506. View

12.

Chen J, Long J, Hurria A, Owusu C, Steingart R, Gross C . Incidence of heart failure or cardiomyopathy after adjuvant trastuzumab therapy for breast cancer. J Am Coll Cardiol. 2012; 60(24):2504-12. DOI: 10.1016/j.jacc.2012.07.068. View

13.

de Azambuja E, Procter M, Van Veldhuisen D, Agbor-Tarh D, Metzger-Filho O, Steinseifer J . Trastuzumab-associated cardiac events at 8 years of median follow-up in the Herceptin Adjuvant trial (BIG 1-01). J Clin Oncol. 2014; 32(20):2159-65. DOI: 10.1200/JCO.2013.53.9288. View

14.

Girre V, Falcou M, Gisselbrecht M, Gridel G, Mosseri V, Bouleuc C . Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?. J Gerontol A Biol Sci Med Sci. 2008; 63(7):724-30. DOI: 10.1093/gerona/63.7.724. View

15.

Romond E, Perez E, Bryant J, Suman V, Geyer Jr C, Davidson N . Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005; 353(16):1673-84. DOI: 10.1056/NEJMoa052122. View

16.

de Glas N, Bastiaannet E, Engels C, de Craen A, Putter H, van de Velde C . Validity of the online PREDICT tool in older patients with breast cancer: a population-based study. Br J Cancer. 2016; 114(4):395-400. PMC: 4815772. DOI: 10.1038/bjc.2015.466. View

17.

Perrone F, Nuzzo F, Di Rella F, Gravina A, Iodice G, Labonia V . Weekly docetaxel versus CMF as adjuvant chemotherapy for older women with early breast cancer: final results of the randomized phase III ELDA trial. Ann Oncol. 2014; 26(4):675-682. DOI: 10.1093/annonc/mdu564. View

18.

Perez E, Romond E, Suman V, Jeong J, Davidson N, Geyer Jr C . Four-year follow-up of trastuzumab plus adjuvant chemotherapy for operable human epidermal growth factor receptor 2-positive breast cancer: joint analysis of data from NCCTG N9831 and NSABP B-31. J Clin Oncol. 2011; 29(25):3366-73. PMC: 3164242. DOI: 10.1200/JCO.2011.35.0868. View

19.

de Glas N, van de Water W, Engelhardt E, Bastiaannet E, de Craen A, Kroep J . Validity of Adjuvant! Online program in older patients with breast cancer: a population-based study. Lancet Oncol. 2014; 15(7):722-9. DOI: 10.1016/S1470-2045(14)70200-1. View

20.

Stuck A, Siu A, Wieland G, Adams J, Rubenstein L . Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993; 342(8878):1032-6. DOI: 10.1016/0140-6736(93)92884-v. View