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Recommendations for use of Trastuzumab (Herceptin®)

Unanswered questions

Important unanswered questions about the use of trastuzumab in metastatic breast cancer and as adjuvant therapy are outlined below; some of these should be addressed in ongoing trials:

  • optimal duration of adjuvant trastuzumab with chemotherapy
  • optimal sequence/timing of adjuvant trastuzumab with chemotherapy
  • continued use of trastuzumab post-progression in patients with metastatic breast cancer
  • use of trastuzumab with other systemic and targeted therapies as adjuvant therapy and in metastatic breast cancer
  • use of trastuzumab as single-agent therapy, as adjuvant therapy, and in metastatic breast cancer
  • use of trastuzumab in patients with node-negative, HER2-positive tumours smaller than 1 cm
  • use of trastuzumab in locally advanced and inflammatory breast cancer
  • use of trastuzumab in older women
  • long-term adverse effects of trastuzumab on cardiac function and the natural history of trastuzumab-induced cardiac dysfunction
  • effect of trastuzumab on the incidence of disease recurrence in the central nervous system
  • long-term benefits and adverse effects of adjuvant trastuzumab
  • quality of life issues associated with the use of trastuzumab
  • use of trastuzumab in pregnancy, and impact on fertility and contraception.

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