- 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%).
- 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.
- 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.