title: 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 trials with available data on the use of adjuvant trastuzumab in patients older than 60years, 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.
authors.affiliation: Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
authors.forename: Janaina
authors.initials: J
authors.lastname: Brollo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Curigliano
authors.forename: Davide
authors.initials: D
authors.lastname: Disalvatore
authors.forename: Bianca Fontana
authors.initials: BF
authors.lastname: Marrone
authors.forename: Carmen
authors.initials: C
authors.lastname: Criscitiello
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bagnardi
authors.forename: Maximiliano Cassilha
authors.initials: MC
authors.lastname: Kneubil
authors.forename: Luca
authors.initials: L
authors.lastname: Fumagalli
authors.forename: Marzia
authors.initials: M
authors.lastname: Locatelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Manunta
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000201:enzymology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005853:Geriatrics / Q000379:methods; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis*; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab