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Master Thesis

Adjuvant systemic therapy for early HER2-positive breast cancer in elderly population

Abstract : Backgroung : HER2-positive tumors represent 10-15% of breast cancers. 40% of breast cancers occur in women aged 65 and older but they are underrepresented in clinical trials. In real life, the standard treatment of anthracycline–taxane based chemotherapy plus one year of trastuzumab may not be appropriate for elderly and patients with co-morbidities. In low risk patients the APT trial demonstrated good outcome without anthracycline. The question is whether this option may be proposed in frail population. The objective of the study is to describe the characteristics of this population and its management in adjuvant setting. Methods : We carried out an observational retrospective study at Centre Eugène Marquis. The patients over 65 years old with early HER2-positive breast cancer diagnosed between 2006 to 2018 were included. We divided the population into 3 treatment groups: Anthracycline-taxanes-trastuzumab regimen (ATTR), Adjuvant paclitaxel-trastuzumab (APT) and Unconventional treatment regimen (UTR). Results : 126 patients were analyzed: 48 patients in ATTR, 49 in APT and 29 in UTR. In overall population, the median follow-up was 35 months [14.3-53] and median age was 73 years old [68,3-79]. A Geriatric Assement (GA) was carried out in only 16%. In the UTR group, patients were more likely to be frail (86.2%, p<0,001) and most of them didn’t received any sytemic anti-HER2 therapy. In ATTR and APT groups, there was no significant difference in terms of cardiac toxicity (8.3% ATTR versus 10.2% APT) and neuropathy (20.8% versus 32.7%), although ATTR group experienced more nausea (37.5% vs 8.2%; p<0,001) and mucositis (39.6% vs 8.2%; p<0,001). After one-year follow-up, there was twice as much loss of autonomy in the UTR group (62.1%) as in the ATTR (29.2%) and APT (36.7%) groups. 14 deaths occurred: 2 deaths in the ATTR group including one toxic death, 4 deaths in the APT group due to metastatic recurrence, 9 deaths in the UTR group including 4 deaths due to metastatic recurrence and 5 deaths by intercurrent diseases such as heart failure and respiratory failure. Conclusion : Our study show the high value of geriatric evaluation to select patient for the best adjuvant treatment in this population. Although short follow-up, undertreatment and clinically relevant side-effects are both ilustrated. Clearly clinical trials should adress new treatment options in this population.
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Master Thesis
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Submitted on : Wednesday, May 26, 2021 - 10:24:15 AM
Last modification on : Tuesday, November 30, 2021 - 3:45:19 AM


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  • HAL Id : dumas-03236101, version 1



Agathe Cochet. Adjuvant systemic therapy for early HER2-positive breast cancer in elderly population. Life Sciences [q-bio]. 2020. ⟨dumas-03236101⟩



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