HER decision.

Can older women with HER2+ early breast cancer omit chemotherapy? This randomized trial sought to determine if disease-free survival at 3 year was non-inferior with trastuzumab alone compared to trastuzumab + chemotherapy in women between age 70 and 80. Most had node negative (~80%), hormone receptor negative (50-55%) disease and underwent mastectomy (~70%). As expected, toxicity was greater in the chemo arm with more than double the rate of grade 3+ non-heme toxicity (12 → 30%). Chemo was also detrimental to quality of life at both 3 months and 1 year. However, 3-year DFS was not found to be non-inferior with trastuzumab alone (90 vs 94%). Restricted mean survival time (wait, what’s that?) at 3 years differed by 0.39 months between groups—meaning there’s likely very little impact on survival with omitting chemotherapy. TBL: In older women with resected, early stage, HER2+ breast cancer, adjuvant trastuzumab alone has less toxicity and better quality of life, but a higher rate of disease-free survival events. | Sawaki, J Clin Oncol 2020