title: Rational use of trastuzumab in metastatic and locally advanced breast cancer: implications of recent research.
abstract: The management of HER2-positive metastatic breast cancer, a disease renowned for its aggressive natural history, has been revolutionized by the introduction of trastuzumab. Indeed, outcomes for patients with HER2-positive advanced breast cancer are now equivalent to, if not better than, those of their HER2-negative counterparts. Since the pivotal registration trial, a wealth of new clinical data has emerged regarding the use of trastuzumab in a variety of clinical contexts - adding to the evidence but also highlighting areas of uncertainly and debate. These include the optimal partner chemotherapy(ies) to trastuzumab; the effectiveness of combining trastuzumab with endocrine therapy; the benefits of continuing trastuzumab after progression on a trastuzumab-containing regimen; and the role of trastuzumab in locally advanced and inflammatory breast cancer. In this paper we review major clinical trials addressing these questions, clinical recommendations that can be made as a result, and the strength of evidence that supports them. Finally, we identify areas of ongoing uncertainty, and propose recommendations for future research in this field.
authors.affiliation: Sydney Cancer Centre (Royal Prince Alfred Hospital), Sydney, New South Wales, Australia.
authors.forename: Shom
authors.initials: S
authors.lastname: Goel
authors.forename: Jacquie
authors.initials: J
authors.lastname: Chirgwin
authors.forename: Prudence
authors.initials: P
authors.lastname: Francis
authors.forename: Robin
authors.initials: R
authors.lastname: Stuart-Harris
authors.forename: Joanna
authors.initials: J
authors.lastname: Dewar
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.forename: Ray
authors.initials: R
authors.lastname: Snyder
authors.forename: Michael
authors.initials: M
authors.lastname: Michael
authors.forename: Bogda
authors.initials: B
authors.lastname: Koczwara
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D018719:Erb-b2 Receptor Tyrosine Kinases; D012008:Recurrence; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab