Tolerability and toxicity of trastuzumab or trastuzumab + lapatinib in older patients: a sub-analysis of the ALTTO trial (BIG 2-06; NCCTG (Alliance) N063D)

Noam Pondé, Dominique Agbor-Tarh, Lissandra Dal Lago, Larissa A. Korde, Florentine Hilbers, Christian Jackisch, Olena Werner, Richard D. Gelber, Aminah Jatoi, Amylou C. Dueck, Alvaro Moreno-Aspitia, Christos Sotiriou, Evandro de Azambuja, Martine Piccart

Research output: Contribution to journalArticlepeer-review


Purpose: Little is known about the use of trastuzumab or trastuzumab + lapatinib in older patients. We have performed a sub-analysis of the Adjuvant Lapatinib And/Or Trastuzumab Treatment Optimisation (ALTTO) trial focused on toxicity and treatment completion of both regimens in older patients (≥ 65 years old) Methods: The ALTTO trial randomised 8381 patients with early HER2-positive BC in 4 arms. Eligible patients for this study were those having received at least one dose of assigned treatment in either the trastuzumab or trastuzumab + lapatinib arms. Treatment completion was evaluated through the rate of temporary treatment interruptions, permanent treatment discontinuations and lapatinib dose reductions. Toxicity was evaluated via a selected subset of adverse events of interest (AEI). Risk factors for both treatment completion outcomes and toxicity were investigated, including comorbidities and use of 5 or more co-medications at randomization. Results: A total of 430 patients ≥ 65 year were eligible. Median age was 68 (range 65–80). In comparison with the younger cohort, older patients had a significantly higher number of comorbidities at randomization (p < 0.001). Treatment completion outcomes were worse, particularly in the trastuzumab + lapatinib arm. Adverse events of interest were likewise more common in the trastuzumab + lapatinib arm with higher AEI rates (63.4% in younger vs 78.0% in older, p < 0.001). Concomitant chemotherapy was associated with worse treatment completion outcomes among older patients. Conclusion: Trastuzumab plus lapatinib was significantly more toxic among older patients and had worse treatment completion. Trastuzumab was generally well tolerated.

Original languageEnglish (US)
Pages (from-to)107-116
Number of pages10
JournalBreast Cancer Research and Treatment
Issue number1
StatePublished - Jan 2021


  • Anti-HER2
  • Breast cancer
  • Geriatric oncology

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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