Whether Elderly Patients with Her-2 Positive Breast Cancer but Without Heart Disease Should Receive Targeted Therapy?
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摘要: 随着我国人口老龄化,乳腺癌治疗需要面对更多的老年患者。近年来,靶向治疗作为人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)阳性乳腺癌全身治疗的重要方法,在乳腺癌治疗中的地位越来越重要。无心脏基础疾病的老年HER-2阳性乳腺癌患者是否应使用曲妥珠单克隆抗体进行靶向治疗存在争议。目前证据表明,60~70岁老年HER-2阳性乳腺癌患者可从曲妥珠单克隆抗体治疗中获益,心脏事件风险较低且可逆,但70岁以上患者目前无大规模试验证据支持。在选择辅助治疗方案时需平衡获益与风险,综合考虑患者本人意愿和身体状况,进行个体化治疗。若治疗选择曲妥珠单克隆抗体,需避免与蒽环类化疗药物联用并监测心功能,及时发现和处理心脏事件。Abstract: With a nationwide increase in elderly population, an increased number of breast cancer diagnosed in older women is expected. Nowadays, targeted therapy is an important systemic treatment for human epidermal growth factor 2 (HER-2) positive breast cancer, which has been playing an important role in the treatment for breast cancer. It is controversial whether trastuzumab should be used for targeted therapy in elderly Her-2 positive breast cancer patients with moderate risk and no cardiac disease. Current evidence suggests that patients aged 60-70 years old with a moderate risk of Her-2 positive breast cancer may benefit from trastuzumab with an acceptable and reversible risk of heart events. Yet there is no enough evidence for elderly patients beyond 70 years old. Therefore, we should balance the benefit and risk when considering targeted therapy for elderly patients with breast cancer. Management of breast cancer in the elderly should take the will of the patients, the physical condition, and comorbidities in to consideration. Anthracycline-based chemotherapy should not be used together with targeted therapy. It is necessary to monitor cardiac function and deal with heart events timely.
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Key words:
- old women /
- breast cancer /
- targeted therapy
利益冲突 无 -
[1] Ferlay J, Soerjomataram I, Dikshit R, et al.Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012 [J]. Int J Cancer, 2015, 372:134-141. doi: 10.1002/ijc.29210 [2] DeSantis CE, Fedewa SA, Goding Sauer A, et al.Breast cancer statistics 2015: convergence of incidence rates between black and white women [J].CA Cancer J Clin, 2016, 66:31-42. doi: 10.3322/caac.21320 [3] Ma C, Zhou Q, Nie X, et al.Breast cancer in Chinese elderly women: pathological and clinical characteristics and factors influencing treatment patterns [J]. Crit Rev Oncol Hematol, 2009, 71: 258-265. doi: 10.1016/j.critrevonc.2008.11.005 [4] Hamaker ME, Schreurs WH, Uppelschoten JM, et al. Breast cancer in the elderly: retrospective study on diagnosis and treatment according to national guidelines [J].Breast, 2009, 15: 26-33. doi: 10.1111/j.1524-4741.2008.00667.x [5] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: breast cancer(Version1.2018) [EB/OL]. https: //www.nccn.org/professionals/physician_gls/default.aspx#breast. https://www.nccn.org/professionals/physician_gls/default.aspx [6] Chavez-MacGregor M, Zhang N, Buchholz TA, et al. Trastuzumab-related cardiotoxicity among older patients with breast cancer[J].Clin Oncol, 2013, 31:4222-4228. doi: 10.1200/JCO.2013.48.7884 [7] World Health Organization. Mental Health of older adults[EB/OL]. http://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults. http://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults [8] Biganzoli L, Wildiers H, Oakman C, et al.Management of elderly patients with breast cancer: updated re-commendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA) [J]. Lancet Oncol, 2012, 13:e148-e160. https://www.sciencedirect.com/science/article/pii/S1743919114008280 [9] Schonberg MA, Marcantonio ER, Li D, et al.Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival [J]. Clin Oncol, 2010, 28: 2038-2045. doi: 10.1200/JCO.2009.25.9796 [10] Wildiers H, Van Calster B, van de Poll-Franse LV, et al. Relationship between age and axillary lymph node involve-ment in women with breast cancer[J]. Clin Oncol, 2009, 27: 2931-2937. doi: 10.1200/JCO.2008.16.7619 [11] Rosso S, Gondos A, Zanetti R, et al. Up-to-date estimates of breast cancer survival for the years 2000-2004 in 11 European countries: the role of screening and a comparison with data from the United States[J]. Eur J Cancer, 2010, 46: 3351-3357. doi: 10.1016/j.ejca.2010.09.019 [12] Bastiaannet E, Liefers GJ, de Craen AJM, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127, 805 unselected pa- tients [J]. Breast Cancer Res Treat, 2010, 124: 801-807. doi: 10.1007/s10549-010-0898-8 [13] Neuner JM, Zokoe N, McGinley EL, et al. Quality of life among a population-based cohort of older patients with breast cancer[J]. Breast, 2014, 23: 609-616. doi: 10.1016/j.breast.2014.06.002 [14] Hurria A, Dale W, Mooney M, et al. Designing therapeutic clinical trials for older and frail adults with cancer: U13 Conference Recommendations [J]. Clin Oncol, 2014, 32: 2587-2594. doi: 10.1200/JCO.2013.55.0418 [15] Derks MGM, Kiderlen M, Bastiaannet E, et al. Large variation in treatment of older patients with nonmetastatic breast cancer in Europe: a population based cohort study from the EURECCA Breast Cancer Group[J]. Lancet Oncol, 2018 (unpublished manuscript). https://pubmed.ncbi.nlm.nih.gov/29875471/ [16] Goldhirsch A, Wood WC, Gelber RD, et al.Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer [J]. Ann Oncol, 2007, 18:1133-1144. doi: 10.1093/annonc/mdm271 [17] Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al.Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer[J].N Engl J Med, 2005, 353:1659-1672. doi: 10.1056/NEJMoa052306 [18] Gianni L, Dafni U, Gelber RD, et al. Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial [J].Lancet Oncol, 2011, 12:236-244. doi: 10.1016/S1470-2045(11)70033-X [19] Slamon D, Eiermann W, Robert N, et al. Adjuvant trastuzumab in HER2-positive breast cancer [J].N Engl J Med, 2011, 365:1273-1283. doi: 10.1056/NEJMoa0910383 [20] Perez EA, Romond EH, Suman VJ, et al. Four-year follow-up of trastuzumab plus adjuvant chemotherapy for operable human epidermal growth factor receptor 2-positive breast cancer: joint analysis of data from NCCTG N9831 and NSABP B-31[J].Clin Oncol, 2011, 29:3366-3373. doi: 10.1200/JCO.2011.35.0868 [21] Cameron D, Piccart-Gebhart MJ, Gelber RD, et al.11 years' follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin Adjuvant (HERA) trial[J]. Lancet, 2017, 389:1195-1205. doi: 10.1016/S0140-6736(16)32616-2 [22] Perez EA, Romond EH, Suman VJ, et al.Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831[J]. Clin Oncol, 2014, 32:3744-3752. doi: 10.1200/JCO.2014.55.5730 [23] Brollo J, Curigliano G, Disalvatore D, et al.Adjuvant trastuzumab in elderly with HER-2 positive breast cancer: a systematic review of randomized controlled trials [J].Cancer Treat Rev, 2013, 39:44-50. doi: 10.1016/j.ctrv.2012.03.009 [24] Michel M, Francesco C, Dominique M, et al. Randomized Phase II Trial of the efficacy and safety of Trastuzumab combined with Docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment:the M77001 study group [J].J Clin Oncol, 2005, 23:4265-4274. https://reference.medscape.com/medline/abstract/15911866 [25] de Azambuja E, Bedard PL, Suter T, et al. Cardiac toxicity with anti-HER-2 therapies: what have we learned so far? [J]. Target Oncol, 2009, 4:77-88. doi: 10.1007/s11523-009-0112-2 [26] de Azambuja E, Procter MJ, van Veldhuisen DJ, et al. Trastuzumab-associated cardiac events at 8 years of median follow-up in the Herception adjuvant trial(BIG 1-01)[J]. Clin Oncol, 2014, 32:2159-2165. [27] Romond EH, Jeong JH, Rastogi P, et al. Seven-year follow up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel(ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer[J]. Clin Oncol, 2012, 30:3792-3799. doi: 10.1200/JCO.2011.40.0010 [28] Zhao YY, Sawyer DR, Baliga RR, et al. Neuregulins promote survival and growth of cardiac myocytes. Persistence of ErbB2 and ErbB4 expression in neonatal and adult ventricular myocytes [J]. Biol Chem, 1998, 273:10261-10269. doi: 10.1074/jbc.273.17.10261 [29] Dall P, Lenzen G, Göhler T, et al. Trastuzumab in the treatment of elderly patients with early breast cancer: Results from an observational study in Germany[J] J Geriatr Oncol, 2015, 6:462-469. doi: 10.1016/j.jgo.2015.06.003 [30] Tolaney SM, Barry WT, Dang CT, et al.Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer[J].N Engl J Med, 2015, 372:134-141. doi: 10.1056/NEJMoa1406281 [31] Du XL, Xia R, Burau K, et al. Cardiac risk associated with the receipt of anthracycline and trastuzumab in a large nationwide cohort of older women with breast cancer, 1998-2005[J]. Med Oncol, 2010, 28:S80-S90. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=a063c87d6d3ab8053c62b723fd982162 [32] Curigliano G, Burstein HJ, P Winer E, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer[J].Anna Oncol, 2017, 28:1700-1712. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887963/
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