title: Safety of adjuvant trastuzumab for HER-2-overexpressing elderly breast cancer patients: a multicenter cohort study.
abstract: 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.
authors.affiliation: Department of Clinical Oncology and Chemotherapy, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. m-sawaki@med.nagoya-u.ac.jp
authors.forename: Masataka
authors.initials: M
authors.lastname: Sawaki
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Mukai
authors.forename: Nahomi
authors.initials: N
authors.lastname: Tokudome
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakayama
authors.forename: Naruto
authors.initials: N
authors.lastname: Taira
authors.forename: Toshiro
authors.initials: T
authors.lastname: Mizuno
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Akiyo
authors.initials: A
authors.lastname: Horio
authors.forename: Toru
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yukari
authors.initials: Y
authors.lastname: Uemura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003520:Cyclophosphamide; D004317:Doxorubicin; D005260:Female; D005472:Fluorouracil; D005500:Follow-Up Studies; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D013997:Time Factors; D000068878:Trastuzumab; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D003520:Cyclophosphamide; D004317:Doxorubicin; D005472:Fluorouracil; D020097:Natriuretic Peptide, Brain; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human