title: Exploring the use and impact of adjuvant trastuzumab for HER2-positive breast cancer patients in a large UK cancer network. Do the results of international clinical trials translate into a similar benefit for patients in South East Wales?
abstract: BACKGROUND
  Trastuzumab was approved in the United Kingdom for adjuvant treatment of human epidermal growth factor receptor 2 (HER2)+ breast cancer in 2006 at significant economic cost and with limited evidence in smaller T1N0 tumours. The South East Wales Cancer Network covers a population of 1,420,000 and maintains a database of treatments used. We examined this database to ensure the outcome of Trastuzumab use is as expected, especially in patients with T1N0 cancers.
  
  
  METHODS
  Case notes of patients with HER2+ disease eligible for adjuvant Trastuzumab over 2005-2008 were reviewed. Disease-free survival (DFS) and overall survival (OS) were calculated with the Kaplan-Meier method using SPSS (version 16.0.01 for Windows, SPSS, Chicago, IL, USA).
  
  
  RESULTS
  A total of 239 of 338 (70.7%) eligible HER2+ patients received treatment. At 3 years, the DFS of the treated group was 90.3% vs 73.3% and the OS was 98.5% vs 87.6%. In all, 47 of 92 stage I patients received Trastuzumab. Despite a trend towards worse prognostic factors in the treated group the DFS was 100% vs 84.1% and the OS was 100% vs 93.3%.
  
  
  CONCLUSIONS
  Our results are comparable to those from landmark Trastuzumab trials. As evidence continues to emerge that smaller HER2+ cancers may behave aggressively our analysis of stage I tumours adds further support to the use of Trastuzumab in these patients.
authors: Department of Clinical Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK. Websterrm@cardiff.ac.uk
authors: R M
authors: RM
authors: Webster
authors: J
authors: J
authors: Abraham
authors: N
authors: N
authors: Palaniappan
authors: A
authors: A
authors: Caley
authors: B
authors: B
authors: Jasani
authors: P
authors: P
authors: Barrett-Lee
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D016019:Survival Analysis; D000068878:Trastuzumab; D006113:United Kingdom; D014852:Wales
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab