HER2+ breast cancer: new treatment recommendations for elderly patients

  • Brain E & al.
  • J Geriatr Oncol
  • 21 Jun 2019

  • Oncology guidelines update
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  • The International Society of Geriatric Oncology issued a position paper with recommendations for treating elderly patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer.
  • Recommendations highlighted the cardiotoxicity of trastuzumab and the higher risk for adverse events associated with the full range of drugs.

Why this matters

  • Guidance has been lacking for the 40% of patients who are elderly and more prone to drug toxicity.
  • Trials often exclude elderly patients despite the fact that they account for a similar percentage of HER2+ tumors (15%-20%).

Study design

  • A task force performed a literature review of Cochrane and PubMed databases to make specific evidence-based treatment recommendations for both fit and frail elderly.
  • Funding: Roche.

Key recommendations

  • Be alert to trastuzumab cardiotoxicity (cardiomyopathy and decline in left ventricular ejection fraction), which increases with age, affecting 2% of young patients and 5% of elderly.
  • Fit elderly can be treated similar to younger patients.
  • In frail elderly with metastatic breast cancer (BCa):
    • Consider avoiding taxanes by substituting with metronomic cyclophosphamide, vinorelbine, or capecitabine, or consider avoiding chemotherapy altogether by prescribing hormonal therapy with hormone-sensitive tumors.
  • In frail elderly with early BCa:
    • Consider trastuzumab without chemotherapy in patients with low-risk tumors.


  • Literature search was restricted to studies published after 2000.

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