Facts and controversies in the use of trastuzumab in the adjuvant setting

Nat Clin Pract Oncol. 2008 Nov;5(11):645-54. doi: 10.1038/ncponc1219. Epub 2008 Sep 9.


The human epidermal growth factor receptor-2 (HER2) is overexpressed and/or amplified in up to 25% of breast cancer patients, and this feature is associated with an aggressive phenotype, high recurrence rate and reduced survival. Until recently, combination chemotherapy (with or without endocrine therapy) was the only effective adjuvant treatment for HER2-positive patients. Trastuzumab is a monoclonal antibody directed against the HER2 extracellular domain, and five recent adjuvant breast cancer trials have demonstrated an astonishing and highly reproducible benefit in halving the recurrence rate and reducing mortality in patients with this phenotype. Many questions related to trastuzumab use in the adjuvant setting still remain; these include the optimum timing and duration of treatment, trastuzumab use with taxanes and radiotherapy, its role in small node-negative tumors, the optimum chemotherapy regimens and cost-effectiveness. This Review outlines the five adjuvant trastuzumab studies and discusses the controversies and challenges that have emerged for both the clinician and healthcare authorities worldwide as a consequence of the results from these trials.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents / therapeutic use*
  • Belgium
  • Biomarkers, Tumor / genetics
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / economics
  • Breast Neoplasms / genetics
  • Breast Neoplasms / mortality
  • Chemotherapy, Adjuvant
  • Clinical Trials as Topic
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Neoplasm Recurrence, Local / economics
  • Neoplasm Recurrence, Local / prevention & control*
  • Phenotype
  • Receptor, ErbB-2 / genetics
  • Risk Assessment
  • Survival Analysis
  • Trastuzumab
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents
  • Biomarkers, Tumor
  • Receptor, ErbB-2
  • Trastuzumab