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3. Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: A systematic review of randomized controlled trials

Author

Brollo, J, Curigliano, G, Disalvatore, D, Marrone, B, Criscitiello, C, Bagnardi, V, Kneubil, M, Fumagalli, L, Locatelli, M, Manunta, S, Goldhirsch, A, Marrone, BF, BAGNARDI, VINCENZO, Kneubil, MC, Goldhirsch, A., Brollo, J, Curigliano, G, Disalvatore, D, Marrone, B, Criscitiello, C, Bagnardi, V, Kneubil, M, Fumagalli, L, Locatelli, M, Manunta, S, Goldhirsch, A, Marrone, BF, BAGNARDI, VINCENZO, Kneubil, MC, and Goldhirsch, A.

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.

Published
2013

4. Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: A systematic review of randomized controlled trials

Author

Vincenzo Bagnardi, Marzia Locatelli, Maximiliano Cassilha Kneubil, Davide Disalvatore, Janaina Brollo, Aron Goldhirsch, Silvia Manunta, Luca Fumagalli, Bianca Fontana Marrone, Carmen Criscitiello, Giuseppe Curigliano, Brollo, J, Curigliano, G, Disalvatore, D, Marrone, B, Criscitiello, C, Bagnardi, V, Kneubil, M, Fumagalli, L, Locatelli, M, Manunta, S, and Goldhirsch, A

Subjects
Oncology, Relative risk reduction, medicine.medical_specialty, Receptor, ErbB-2, medicine.medical_treatment, Breast Neoplasms, Antibodies, Monoclonal, Humanized, law.invention, Breast cancer, Randomized controlled trial, law, Trastuzumab, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, medicine, Adjuvant therapy, Humans, Radiology, Nuclear Medicine and imaging, skin and connective tissue diseases, neoplasms, Aged, Randomized Controlled Trials as Topic, Aged, 80 and over, Chemotherapy, business.industry, Hazard ratio, General Medicine, Middle Aged, medicine.disease, Adjuvant treatment, Trastuzumab, Breast cancer, Elderly patients, Geriatric oncology, Systematic review, Chemotherapy, Adjuvant, Geriatrics, Female, business, Adjuvant, medicine.drug
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.

Published
2013

5. Breast cancer subtype approximations and loco-regional recurrence after immediate breast reconstruction.

Author

Kneubil MC, Brollo J, Botteri E, Curigliano G, Rotmensz N, Goldhirsch A, Lohsiriwat V, Manconi A, Martella S, Santillo B, Petit JY, and Rietjens M

Subjects
Adult, Aged, Body Mass Index, Breast Neoplasms chemistry, Breast Neoplasms etiology, Breast Neoplasms therapy, Chemotherapy, Adjuvant, Female, Follow-Up Studies, Humans, Incidence, Italy epidemiology, Ki-67 Antigen analysis, Lymphatic Metastasis, Middle Aged, Multivariate Analysis, Neoplasm Grading, Neoplasm Recurrence, Local epidemiology, Neoplasm Staging, Obesity metabolism, Proportional Hazards Models, Radiotherapy, Adjuvant, Receptor, ErbB-2 analysis, Receptors, Estrogen analysis, Receptors, Progesterone analysis, Retrospective Studies, Risk Factors, Time Factors, Biomarkers, Tumor analysis, Breast Neoplasms pathology, Breast Neoplasms surgery, Mammaplasty, Neoplasm Recurrence, Local etiology, Obesity complications
Abstract

Background: A small but significant proportion of patients with breast cancer (BC) will develop loco-regional recurrence (LRR) after immediate breast reconstruction (IBR). The LRR also varies according to breast cancer subtypes and clinicopathological features., Methods: We studied 1742 consecutive BC patients with IBR between 1997 and 2006. According to St Gallen conference consensus 2011, its BC approximations were applied to classify BC into five subtypes: estrogen receptor (ER) and/or progesterone receptor (PgR) positive, HER2 negative, and low Ki67 (<14%) [luminal A]; ER and/or PgR positive, HER2 negative and high Ki67(≥ 14%) [luminal B/HER2 negative]; ER and/or PgR positive, any Ki67 and HER2 positive [luminal B/HER2 positive]; ER negative, PgR negative and HER2 positive [HER2 positive/nonluminal]; and ER negative, PgR negative and HER2 negative [triple negative]. Cumulative incidences of LRR were compared across different subgroups by means of the Gray test. Multivariable Cox regression models were applied., Results: Median follow up time was 74 months (range 3-165). The cumulative incidence of LRR was 5.5% (121 events). The 5-year cumulative incidence of LRR was 2.5% for luminal A; 5.0% for luminal B/HER2 negative; 9.8% for luminal B/HER2 positive; 3.8% for HER2 non luminal; and 10.9% for triple negative. On multivariable analysis, tumor size (pT) >2 cm, body mass index (BMI) ≥ 25, triple negative and luminal B/HER2 positive subtypes were associated with increased risk of LRR., Conclusion: Luminal B/HER2 positive, triple negative subtypes and BMI ≥ 25 are independent prognostic factors for risk of LRR after IBR., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Published
2013
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