title: Adjuvant targeted therapy in early breast cancer.
abstract: For this review, the authors appraised the evidence for adjuvant trastuzumab therapy in early breast cancer. There was level 1 evidence to support the routine use of 1 year of adjuvant trastuzumab in conjunction with chemotherapy for women with human epidermal growth factor receptor 2 (HER-2)-positive early breast cancer. The relative benefits of concurrent versus sequential administration remained unclear; however concurrent administration permitted the earliest possible intervention with trastuzumab with possible superiority. There was evidence to support the use of trastuzumab in both lymph node-positive and high-risk lymph node-negative patients, and preliminary data suggested that all patient subgroups that were eligible for the trials benefit equally from trastuzumab. Adjuvant trastuzumab was associated with a risk of cardiotoxicity, the long-term impact of which remains largely unknown. Routine cardiac risk assessment considering left ventricular ejection fraction, age, and prior history of cardiac events is recommended along with the selection of trastuzumab-based regimens that minimize cardiotoxicity. Trastuzumab acquisition costs for 1 year of therapy were the largest component of treatment costs.
authors.affiliation: Cross Cancer Center, Edmonton, Alberta, Canada. johnmack@cancerboard.ab.ca
authors.forename: John
authors.initials: J
authors.lastname: Mackey
authors.forename: Deanna
authors.initials: D
authors.lastname: McLeod
authors.forename: Joseph
authors.initials: J
authors.lastname: Ragaz
authors.forename: Karen
authors.initials: K
authors.lastname: Gelmon
authors.forename: Sunil
authors.initials: S
authors.lastname: Verma
authors.forename: Kathleen
authors.initials: K
authors.lastname: Pritchard
authors.forename: Kara
authors.initials: K
authors.lastname: Laing
authors.forename: Louise
authors.initials: L
authors.lastname: Provencher
authors.forename: Lauren F
authors.initials: LF
authors.lastname: Charbonneau
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D016503:Drug Delivery Systems; D005260:Female; D017048:Health Care Costs; D006321:Heart / Q000187:drug effects; D006801:Humans; D011788:Quality of Life; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068878:Trastuzumab