only arise years after cancer treatment. It is one of the lesscommon adverse effect that has been reported with conventionalchemotherapy such as anthracyclines but targeted therapies suchas anti-human epidermal growth factor receptor-2 (HER2), such astrastuzumab have not been spared either.

Approximately 20% of breast cancer tumours overexpress HER2and this subgroup has been reported to be more aggressive and isassociated with poorer treatment prognosis. Trastuzumab is ahumanised monoclonal antibody that targets the extracellulardomain of HER2 receptor. It has been used to treat HER2 positivebreast cancer in both metastatic and adjuvant settings but its efficacyhas been limited with the occurrence of cardiotoxicity. Compared toanthracyclines, cardiotoxicity arising from targeted therapy differssuch as in terms of clinical presentation, risk factors and treatment.

With newer drugs such as pertuzumab and ado-trastuzumabemtansine, for the treatment of HER2-positive breast cancer andpotentially the use of dual HER2 targeted therapy, cardiotoxicityremains a true concern that requires careful surveillance. Hence, inrecent years, the area of cardio-oncology is rapidly gaining interestamong clinicians. Further research is warranted to aid clinicians inbetter preventive and surveillance measures for cardiotoxicity associ-ated with breast cancer therapy. Prompt treatment can then berendered if required andhopefully avoiding serious, long term sequelae.

At the end of the session, participants should be able to

• List the common chemotherapy and/or targeted therapies that cancause cardiotoxicity.

• Distinguish cardiotoxicity arising from conventional chemotherapyand targeted agents.

• Discuss the appropriate preventive, monitoring and treatment ofcardiotoxicity caused by drugs used in cancer therapy.

Disclosure of Interest: None declared.

Keywords: Cardiotoxicity, anthracyclines, HER2 therapy.

doi:10.1016/j.jgo.2014.06.012

S09COMMUNICATING TREATMENT OPTIONS TO OLDER PATIENTS:CHALLENGES AND OPPORTUNITIESArti Hurria, MDDepartment of Medical Oncology and Therapeutics Research, City ofHope National Medical Center, Duarte, California, USA

A key component of care of older patients is the recognition thatchronologic age alone cannot guide the management of an older adultwith cancer. Treatment decisions must also take into account anindividual’s functional status, cognition, the risks and benefits of therapy,and patient preference (which can be influenced by socioeconomicfactors such as finances, spirituality, culture, and social support). High-quality cancer care should be evidence-based and patient-centered.

The discussion regarding treatment options involves balancing thebenefits of specific therapies with the possibility for increasedtreatment-related toxicity potentially exacerbated by physiologicaldecline or comorbidities that often co-exist in the older population.The number of older adults with cancer is increasing,1 but older adultsremain underrepresented on cancer clinical trials.2-4 Furthermore,studies often exclude older adults with comorbid medical conditionsor organ dysfunction. In order to prepare for the challenges that willresult from the aging of the world’s population, it is important toincrease the breadth and depth of data obtained from cancer clinicaltrials.5 Efforts should be made to match the characteristics of the studypopulation to that of patients with the disease (i.e., enroll older patientsand individuals with multiple comorbid conditions onto clinical trials).

In addition, clinical oncology trials should capture a more detailedcharacterization of the study population through evaluation tools suchas a comprehensive geriatric assessment (CGA),6 which can assess theunique needs of older adults with cancer and identify those who aremost at risk for treatment-related adverse side effects.7

Among older adults, cancer is often only one of multiple coexistinghealth conditions. Physical, cognitive, or emotional issues only add tothe complexity of their care needs. The goals of cancer care may bedifferent for older adults. The typical goals of cancer care can bedramatically influenced by the health and social issues experienced byolder adults, with an emphasis on quality of life playing a critical role inwhich treatments they arewilling to accept. In fact, the effects of cancertherapies on physical or cognitive function could be just as important, ifnot more important, to older patients than response or survival.8 It isalso important to take into account the need for caregiver supportduring and after therapy, since many individuals caring for olderpatients with cancer are often older adults themselves.

Olderpatientswith cancer shouldbe supported throughout thedecisionmaking process so that they can understand their options and be able toselect a treatment that fits their overall goals, values, and preferences.

Disclosure of interest: Dr. Hurria has received research supportfrom Celgene Corporation and GlaxoSmithKline, and has served as aconsultant for GTx, Inc. and Seattle Genetics.

Keywords: cancer; older patient; therapeutic management; geriatricassessment; clinical trials

References[1] Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence

in the United States: burdens upon an aging, changing nation. JClin Oncol 2009;27:2758–2765.

[2] Talarico L, Chen G, Pazdur R, et al. Enrollment of elderlypatients in clinical trials for cancer drug registration: a 7-yearexperience by the US Food and Drug Administration. J Clin Oncol2004;22:4626–4631.

[3] Hutchins LF, Unger JM, Crowley JJ, et al. Underrepresentation ofpatients 65 years of age or older in cancer-treatment trials. NEngl J Med 1999;341:2061–2067.

[4] Scher KS, Hurria A, Peterson BL, et al. Under-representation ofolder adults in cancer registration trials: known problem, littleprogress. J Clin Oncol 2012;30:2036–2038.

[5] Levit LA, Balogh E, Nass SJ, et al. Delivering high-quality cancercare : charting a new course for a system in crisis. Washington,D.C. The National Academies Press; 2013.

[6] Hurria A, Gupta S, Zauderer M, et al. Developing a cancer-specificgeriatric assessment: a feasibility study.Cancer 2005;104:1998–2005.

[7] Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapytoxicity in older adults with cancer: a prospective multicenterstudy. J Clin Oncol 2011;29:3457–3465.

[8] Fried TR, Bradley EH, Towle VR, et al. Understanding the treatmentpreferences of seriously ill patients.NEngl JMed2002;346:1061–1066.

doi:10.1016/j.jgo.2014.06.013

S10DO ELDERLY PATIENTS BENEFIT FROM ENROLLMENT INTOPHASE I TRIALSDavid Tai1,*1Division of Medical Oncology, National Cancer Center Singapore,Singapore

Background: Despite the significant burden of cancer in the olderpopulation, their outcomes in the context of phase I studies havebeen poorly studied. We evaluated the clinical characteristics and

SIOG APAC 2014 Invited Speakers Abstract submissionS4