This Article Full Text Full Text (PDF) All Versions of this Article: theoncologist.2009-0056v1 14/9/883    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Google Scholar Articles by Hurria, A. Articles by Naeim, A. PubMed PubMed Citation Articles by Hurria, A. Articles by Naeim, A.

Geriatric Oncology

Perspectives and Attitudes on the Use of Adjuvant Chemotherapy and Trastuzumab in Older Adults with HER-2⁺ Breast Cancer: A Survey of Oncologists

^aCity of Hope, Duarte, California, USA; ^bUniversity of California, Los Angeles, California, USA

Key Words. Adjuvant treatment • Elderly • Geriatric oncology • Trastuzumab

Correspondence: Arti Hurria, M.D., City of Hope, 1500 E. Duarte Road, Duarte, California 91010, USA. Telephone: 626-256-4673, ext 64173; Fax: 626-301-8898; e-mail: ahurria{at}coh.org

Received March 20, 2009; accepted for publication July 27, 2009; first published online in THE ONCOLOGIST Express on September 2, 2009.

Disclosures: Arti Hurria: Consultant/advisory role: CALGB member, ASCO Education Committee, NCCN Senior Adult Oncology Committee, Genentech, Amgen; Research funding/contracted research: Abraxis Bioscience, Pfizer; F. Lennie Wong: None; Sumanta Pal: None; Cathie T. Chung: Honoraria: Lilly; Research funding/contracted research: Pfizer; Smita Bhatia: None; Joanne Mortimer: None; George Somlo: None; Sara Hurvitz: Research funding/contracted research: Genentech, Roche; Doojduen Villaluna: None; Arash Naeim: Consultant/advisory role: Amgen; Honoraria: Amgen; Research funding/contracted research: Pfizer, Amgen, Genentech.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Background. Substantial evidence supports the use of adjuvant trastuzumab with chemotherapy for patients with human epidermal growth factor receptor (HER)-2⁺ breast cancer; however, a lesser amount of data is available to guide use of this therapy in older patients and in those with significant medical comorbidities. The goal of the current study was to understand how patient age and health status impact oncologists' decisions to recommend adjuvant therapy in older women with HER-2⁺ breast cancer.

Methods. Medical oncologists (n = 151) participated in an online survey regarding treatment recommendations for a hypothetical patient of varying age and health status with tumor stage 2, nodal stage 2, estrogen receptor–negative, HER-2⁺ breast cancer. Survey respondents recommended either chemotherapy plus trastuzumab, chemotherapy alone, trastuzumab alone, or no therapy. The effect of age and health status on therapeutic recommendations was assessed.

Findings. As the hypothetical patient's age increased or health status deteriorated, oncologists were less likely to recommend a combination of chemotherapy plus trastuzumab. In contrast, oncologists were more likely to recommend either trastuzumab alone or no therapy for patients with advanced age and deteriorating health status. Chemotherapy alone was recommended by only 7.5% of respondents, on average.

Interpretation. With limited evidence-based data for the treatment of older women with early-stage HER-2⁺ breast cancer, medical oncologists recommend a diverse array of therapeutic approaches. With increasing age and declining health status they were less likely to recommend chemotherapy plus trastuzumab and more likely to recommend single-agent trastuzumab or no therapy.