Breast Cancer Coverage from Every Angle

Trastuzumab Monotherapy for Older Patients With HER2-Positive Breast Cancer

By: Hope Craig, MSPH
Posted: Tuesday, December 1, 2020

Trastuzumab monotherapy may prove to be an effective adjuvant therapy for older patients with HER2-positive early breast cancer. In a randomized controlled trial published in the Journal of Clinical Oncology, Masataka Sawaki, PhD, of the Aichi Cancer Center Hospital, Japan, and colleagues showed the relative value of trastuzumab monotherapy versus trastuzumab with chemotherapy in this patient population.

“In patients 70 years of age who need to avoid chemotherapy because of contraindications or patient preference, especially patients aged 75 years with performance status 1 disease and estrogen-receptor positivity, we found relatively small influences on chemotherapy effects. With lower toxicity and better health-related quality-of-life profile, trastuzumab monotherapy can be a reasonable option for selected older patients with favorable outcomes,” the authors commented.

The study included 275 patients (mean age, 73.5 years), most of whom had stage I (43.6%) or stage IIA (41.7%) breast cancer. Notably, the primary study objective of noninferiority for trastuzumab monotherapy was not met; however, the observed loss of survival at 3 years without chemotherapy was less than 1 month. The 3-year disease-free survival was 89.5% with trastuzumab monotherapy compared with 93.8% with trastuzumab plus chemotherapy (hazard ratio = 1.36).

Further, the rate of clinically meaningful health-related quality-of-life deterioration showed significant differences at 2 months and at 1 year for both treatment groups (31% with trastuzumab monotherapy vs. 48% with trastuzumab plus chemotherapy, P = .016). The most common adverse events were anorexia (7.4% with trastuzumab monotherapy and 44.3% with trastuzumab plus chemotherapy) and alopecia (2.2% vs. 71.7%). In addition, fewer grade 3 or 4 nonhematologic adverse events were observed with trastuzumab monotherapy versus trastuzumab plus chemotherapy (11.9% vs. 29.8%).

“Consequently, health-related quality-of-life deterioration, even if temporary, is important when deciding whether to receive chemotherapy,” the authors noted.

Disclosure: For full disclosures of the study authors, visit

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