The National Comprehensive Cancer Network (NCCN) guidelines and the Chinese Anti-Cancer Society Breast Cancer Guidelines and Specifications 2013 Edition both state that HER-2-positive early-stage breast cancer should receive standard treatment with trastuzumab for 1 year. The results of the BCIRG 006 study, the NSABP B-31 study, and the NCCTG N9831 study all showed that trastuzumab in combination with chemotherapy significantly reduced the risk of recurrence and death.
So when to start trastuzumab? The results of the FNCLCC-PACS-04 trial, published in 2009, showed that in patients with lymph node-positive locally progressive HER-2-positive breast cancer, sequential administration of trastuzumab after chemotherapy was not as effective as concurrent combination with trastuzumab.
In general, doctors generally recommend that breast cancer patients start trastuzumab immediately after surgery in combination with chemotherapy. Of course, it is important to follow your doctor’s advice on a case-by-case basis. (Contributed by Yuan Min, Department of Medical Oncology, Shanghai Tenth People’s Hospital)