Treatment of HER-2 positive breast cancer

HER-2 is considered a prognostic and predictive factor in early breast cancer, and it is fundamental for the decision about adjuvant systemic therapy. HER-2 is recognised as a strong predictive factor for the efficacy of chemotherapy-containing anthracyclines even if there are no prospective but only restrospective analysis from adjuvant chemotherapy trials comparing anthracyclines-containing chemotherapy to CMF or similar regimens. More contradictory is the role of HER-2 as predictive factor for the treatment with adjuvant chemotherapy-containing antharcyclines and taxanes compared to only anthracyclines. In the treatment of early breast cancer adjuvant trastuzumab reduces the risk of recurrence and death if added to chemotherapy. Trastuzumab can be administered in different ways but the concomitant administration with chemotherapy (taxanes), compared to sequential administration, reduces the risk of recurrence significantly. At the same time the risk of cardiotoxicity is increased using the concomitant instead of the sequential administration.