Rounds with the Investigators 2012 | Breast Cancer

QUESTION: What do you do with a woman in her late eighties or nineties, very vigorous, with a HER2-positive tumor? This is coming up fairly frequently.

DR HAROLD BURSTEIN: With regard to the 90-year-old, I would treat her very gently, and maybe a little touch of paclitaxel/trastuzumab, as we’ve talked about for some of our other low-risk patients, and see how she does.

DR SARA HURVITZ: Would you use vinorelbine?

DR BURSTEIN: I could. Sure.

DR LOVE: Is there an age limit to your T-DM1 adjuvant trial coming up?

DR BURSTEIN: 112!

DR LOVE: I guess you can’t get survival benefit at that age.

DR BURSTEIN: I’m sure there is not, because you’re not allowed to write studies that have age limits. So I’m sure there is not an age limit. Again, HER2-positive disease, going back to Dennis’ original 1986 paper, is much more common in younger women. It is unusual to see a 90-year-old. And I would retest the tumor for HER2 status.

DR KENNETH HOFFMAN: I think it’s important in this instance to be very careful dealing with elderly individuals, to make sure that ambulation and neurologic function is intact. And I’m really very wary when dealing with peripheral neurotoxicity, whether it be any of the spindle cell blockers, because once they trip and once they fall and if they’re on Coumadin^® or if they’re on anything else, or they fracture something, then you’re dealing with a whole different kettle of fish. And being 90 years old, irrespective of whether you make Moses’ years or not, or 30, the fact is you’re really dealing here with performance status, performance status and performance status.

DR BURSTEIN: Well, even a 90-year-old with —

DR HOFFMAN: With survival.

DR BURSTEIN: — a perfect performance status still only has a life expectancy of about 6 to 8 years, demographically.

DR HOFFMAN: Right.

DR BURSTEIN: And so you’ve really got to be wondering why you’re giving it.