Trastuzumab Beyond Disease Progression: Case Closed?

Division of Medical Oncology, Institute for Cancer Research and Treatment, Candiolo, Italy Von Minckwitz et al1 reported in Journal of Clinical Oncology the first and only, to our knowledge, partially successful attempt at studying prospectively the value of continuing trastuzumab in addition to chemotherapy in patients with human epidermal growth factor receptor 2 (HER2) –positive advanced breast cancer in whom a previous trastuzumab-containing line of treatment had failed. First of all, we would like to congratulate the authors on enrolling a sufficient number of patients to draw statistically significant conclusions about this controversial topic in breast oncology, a field in which others had previously failed to do so. However, we believe that the results reported by von Minckwitz et al leave open two main questions. First, were the 156 patients enrolled onto this trial representative of the population of patients in whom a trastuzumab-based regimen has failed and for whom we have to choose the most appropriate salvage treatment in our daily practice? Second, how will these results fit into the current scenario regarding management of HER2-positive disease? .......................