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Significant advances have been made in cancer therapy over the past 2 decades, spurring development of clinical pharmacy services and optimization of drug therapies. Scrutiny of clinical information for accuracy dispels misconceptions and ensures medication safety, as illustrated by this note pertaining to oncology.

Current accepted standards in oncology practice state that, for patients with early-stage, HER2-positive invasive breast cancer with a tumor size of 1 cm or greater, if patients are candidates for preoperative (or neoadjuvant) therapy, trastuzumab (or trastuzumab hyaluronidase or an available trastuzumab biosimilar) plus taxane-based chemotherapy with or without pertuzumab is generally recommended.1 After surgery, if patients achieve pathological complete response (ie, have no residual disease in the breast or lymph nodes based on microscopic evaluation), postoperative (or adjuvant) therapy with trastuzumab (with or without pertuzumab) should be considered to reduce risk of cancer recurrence. Conversely, if patients do not achieve pathological complete response or have residual disease, ado-trastuzumab emtansine should be offered after surgery, based on a landmark phase 3 trial (Katherine trial)2 that demonstrated significantly improved invasive disease–free survival with ado-trastuzumab emtansine in comparison to trastuzumab (hazard ratio, 0.50; 95% confidence interval [CI], 0.39-0.64; P < 0.0001) in interim analysis. Although clinical efficacy has been observed in select patients who received 6 months3 or extended4 (1 year of trastuzmab, 1 year of neratinib) HER2-targeted therapy, it is generally recommended that patients with HER2-positive early breast cancer without contraindications be offered 1 year total (counting from the beginning of neoadjuvant and/or adjuvant treatment) of trastuzumab-based therapy.1,5 The current National Comprehensive Cancer Network guideline5 also states that duration of trastuzumab therapy for longer than 12 months does not have added benefit, while therapy for less than 12 months is found to be less effective than that for 12 months.

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