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Trastuzumab as adjuvant systemic therapy for HER2-positive breast cancer

Nature Clinical Practice Oncology volume 6, pages 93–104 (2009)Cite this article

Abstract

Trastuzumab has an established role for the treatment of HER2-positive early-stage breast cancer because of the success of this agent in the adjuvant setting. Several key questions about the value of trastuzumab for the treatment of breast cancer, however, still need to be answered. Various differences in patient characteristics and treatment regimens were present in the randomized trials discussed in this Review; therefore, the details of trastuzumab use need clarification. For example, the optimum timing, the ideal administration schedule, and the appropriate length of treatment are not known. Cardiotoxicity is major concern even though the results of all randomized trials have shown that the degree of cardiotoxicity with trastuzumab is acceptable—the incidence of cardiac damage caused by trastuzumab ranged from 0.4% to 4.1% in the different trials (cumulative incidence of congestive heart failure, New York Heart Association class 3–4). Current data do not support the use of trastuzumab for more than 1 year. The analysis of 2-year treatment with trastuzumab is expected to be available in 2009.

Key Points

  • Adjuvant trastuzumab has an established role in daily clinical practice in patients with HER2-positive breast cancer

  • Cardiotoxicity of trastuzumab is major concern, even though the results of all randomized trials have shown that the degree of cardiac toxic effects produced by trastuzumab is acceptable

  • The incidence of cardiac damage due to trastuzumab ranged from 0.4% to 4.1% in the different randomized trials (cumulative incidence of congestive hearth failure, New York Heart Association class 3–4)

  • Several differences exist in the design and outcomes of the randomized trials of adjuvant trastuzumab; as a result, the optimum timing, schedule and length of treatment with trastuzumab is not known

  • Currently data do not support use of trastuzumab for more than 1 year

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Figure 1: Schema showing chemotherapy schedules and different trastuzumab timing in randomized adjuvant trials.

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Authors and Affiliations

  1. G Mariani is a Staff Member at the Department of Medical Oncology, E De Benedictis is completing her fellowship in Medical Oncology and L Gianni is Director of the Division of Medical Oncology 1, A Fasolo is a Medical Oncologist, all at Istituto Nazionale Tumori, Milan, Italy.,

    Gabriella Mariani, Angelica Fasolo, Elena De Benedictis & Luca Gianni

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  1. Gabriella Mariani
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  2. Angelica Fasolo
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Correspondence to Luca Gianni.

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Luca Gianni declared he is a consultant for Genentech, GlaxoSmithKline, Roche and Wyeth. The other authors declared no competing interests.

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Mariani, G., Fasolo, A., De Benedictis, E. et al. Trastuzumab as adjuvant systemic therapy for HER2-positive breast cancer. Nat Rev Clin Oncol 6, 93–104 (2009). https://doi.org/10.1038/ncponc1298

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