Patient Selection and Adjuvant Trastuzumab Therapy
➤ Only patients with HER2-positive breast cancer (overexpressed based on
immunohistochemistry [3+] or amplified based on in situ hybridization
[ratio >2.0 or average HER2 copy number ≥6.0]) should be offered
adjuvant trastuzumab.
Trastuzumab Plus Chemotherapy in Patients with Higher-Risk
HER2-Positive Disease
➤ Trastuzumab plus chemotherapy is recommended for all patients with HER2-
positive, node-positive breast cancer and for patients with HER2-positive,
node-negative breast cancer (>1 cm).*
Trastuzumab Plus Chemotherapy in Patients with HER2-
Positive T1a-B N0 Disease
➤ Trastuzumab therapy can be considered in small, node-negative tumors
(≤1 cm).
Selection of Chemotherapy Regimens in Patients Receiving
Trastuzumab
➤ Trastuzumab can be administered with any acceptable adjuvant chemotherapy
regimen.*
Use of Trastuzumab and an Anthracycline-Containing Regimen
➤ The administration of trastuzumab concurrently with the anthracycline
component of a chemotherapy regimen is NOT recommended because of the
potential for increased cardiotoxicity.
Concurrent Administration of Adjuvant Trastuzumab and
Non-Anthracycline Chemotherapy Regimens
➤ Trastuzumab should be preferentially administered concurrently (not
sequentially) with a non-anthracycline chemotherapy regimen.
Trastuzumab-Based Chemotherapy or Trastuzumab Regimens
For Patients at Higher Risk of Cardiotoxicity
➤ Less cardiotoxicity is seen with docetaxel-carboplatin-trastuzumab than with
doxorubicin-cyclophosphamide → docetaxel-trastuzumab, and docetaxel-
carboplatin-trastuzumab is recommended for patients at higher risk for
cardiotoxicity.*
