Traitement adjuvant et néoadjuvant des cancers du sein HER2 positifs chez les sujets âgés

Abstract : Background: one year of adjuvant Trastuzumab for human epidermal growth factor receptor-2 (HER2)-positive early breast cancer is the standard of care. Although patients ≥70 years represents 46 % of breast cancer population, only a minority of them are included in clinical trials. Data regarding the efficacy and safety of trastuzumab-based chemotherapy in this population are limited. Material and methods: we aimed to evaluate the safety and efficacy of trastuzumab-based treatment in a multicentric retrospective cohort of patients with HER2-positive early breast cancer ≥70 years, treated with at least one injection of trastuzumab in two comprehensive cancer centers in France.We described patients and treatment characteristics and factors associated with the use of anthracyclines. We also assessed factors associated toxicity of chemotherapy, Trastuzumab completion,cardiac toxicity, distant invasive-disease-free survival and overall survival. Results: between January the 1st 2007 and December the 31st 2017,231 patients were included with a median follow-up of 62.3months. Median age at diagnosis was 75 years (range 70-94).. One hundred and three patients (44,6%) had a comorbidity score > 5. Seventy-seven patients (33,3%) received anthracycline-taxanes based therapy, 8 (3,5%) received anthracycline-based therapy without taxanes,30 (13%) received taxanes- based multidrug regimen therapy, 68 (29,4 %) received single agent taxanes, 21 (9,1%) received other chemotherapy agents, 27 (11,7 %) received trastuzumab without chemotherapy. Among the 204 patients who received chemotherapy, 38 (18,6%) ended it up prematurely because of toxicity. Toxicity-associated hospitalization occurred in 39 patients (19,4%). Number of medication ≥ 3 was associated with chemotherapy toxicity OR=2,4 CI95% [1.2-4.5] p=0,006. Twenty-eight patients (12,12%) developed at least one cardiac event during chemotherapy or Trastuzumab. One hundred and ninety-seven patients (87,56%) completed ≥ 9 months of trastuzumab. Age>, ECOG-PS≥2 and presence of cardiac comorbidities was associated with worse Trastuzumab completion in a multivariate analysis. Five-years OS was 88,3% IC95% [82.4-92.3]. Non anthracycline or taxane based chemotherapy was associated with worse overral survival. Five-years invasive disease-free survival was 81.9% CI95% [75.5; 86.9]. Conclusion: adjuvant Trastuzumab-based chemotherapy is feasible and beneficial in elderly patients but can lead to a substantial toxicity, especially cardiac. Undertreatement could result in lower outcome. Prospective studies are needed to define optimal treatment and standardize practices for this population.
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Master Thesis
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Submitted on : Wednesday, January 9, 2019 - 3:49:03 PM
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Mylène Annonay. Traitement adjuvant et néoadjuvant des cancers du sein HER2 positifs chez les sujets âgés. Médecine humaine et pathologie. 2018. ⟨dumas-01975885⟩

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