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I have an article printed in the New England journal of medicine in October 2005 (Vol 353 No. 16). This discusses Herceptin after Adjuvant chem. In HER2 + breast cancer.



http://content.nejm.org/cgi/content/full/353/16/1659



The discussion of this article is:

This study shows that trastuzumab can benefit women with HER2-positive breast cancer when given after completion of adjuvant chemotherapy. As compared with observation after primary therapy (including surgery with or without radiotherapy and neoadjuvant or adjuvant chemotherapy), trastuzumab given after primary therapy reduced the rate of recurrence, particularly distant recurrence, by approximately 50 percent. This degree of benefit in early breast cancer is the largest to be reported since the introduction of tamoxifen in hormone-receptor–positive disease.

Another concern is that longer follow-up may show that trastuzumab is not effective in reducing the incidence of disease recurrence in the central nervous system. Brain metastases developed in approximately one third of the women receiving trastuzumab as treatment for advanced breast cancer, despite control of systemic disease.

At a median of one year of follow-up, trastuzumab improved the disease-free survival in all subgroups, further follow-up may show that the magnitudes of absolute benefit differ across subgroups. For example, almost 60 percent of the disease-free–survival events observed so far occurred in the hormone-receptor–negative cohort (48 percent of the patients), but we cannot rule out the possibility that in the future disease-free–survival events may occur disproportionately more often among patients in the subgroup with hormone-receptor–positive tumors. By design, women with cardiac risk factors and an LVEF of less than 55 percent after completion of chemotherapy with or without radiotherapy were excluded from the study, and our data are not applicable to the treatment of such women.

The results of this trial indicate that one year of adjuvant trastuzumab should be considered a standard option on completion of locoregional therapy and neoadjuvant or adjuvant chemotherapy for women who fulfill the study eligibility criteria used in the HERA trial.