The National Institute of Health and Clinical Excellence (NICE) has published a technology appraisal on the use of trastuzumab in early breast cancer.
NICE recommend that trastuzumab (Herceptin®) is given to women with early stage HER2-positive breast cancer after they have had surgery and chemotherapy (and radiotherapy if appropriate). It should be given every three weeks for a period of twelve months or until the breast cancer returns, which ever is sooner, provided that the patient has good cardiac function.
Before treatment is started cardiac function should be assessed. Treatment should not be offered if the patient has:
- a left ventricular ejection fraction (LVEF) of 55% or less
- a history of documented congestive heart failure
- high-risk uncontrolled arrhythmias
- angina pectoris requiring medication
- clinically significant valvular disease
- evidence of transmural infarction on electrocardiograph (ECG)
- poorly controlled hypertension
NICE also recommend that cardiac assessments are carried out every 3 months and treatment suspended if LVEF drops below 50% or by 10% from the baseline.
Action: The use of trastuzumab in early-stage breast cancer has been the subject of huge media interest. Clinicians may wish to be aware of the latest developments.