Trastuzumab (Herceptin®) – Advanced breast cancer

NICE recommendations, summary of meeting discussions, links to additional supporting docs etc.

March 2002 NICE TA 34:

Trastuzumab in combination with paclitaxel (combination trastuzumab is currently only licensed for use with paclitaxel) is recommended as an option for people with tumours expressing human epidermal growth factor receptor 2 (HER2) scored at levels of 3+ who have not received chemotherapy for metastatic breast cancer and in whom anthracycline treatment is inappropriate.

Trastuzumab monotherapy is recommended as an option for people with tumours expressing HER2 scored at levels of 3+ who have received at least two chemotherapy regimens for metastatic breast cancer. Prior chemotherapy must have included at least an anthracycline and a taxane where these treatments are appropriate. It should also have included hormonal therapy in suitable oestrogen receptor positive patients.

(NICE TA 34 is due to be updated by NICE)

March 2009: The TAG noted NICE Clinical Guideline No.81 Advanced Breast Cancer, which states that for patients who are receiving trastuzumab for advanced breast cancer, treatment with trastuzumab should be discontinued at the time of disease progression outside the central nervous system. Trastuzumab should not be discontinued if disease progression is within the central nervous system alone.

For patients who are HER2 +ve who have previously been treated with trastuzumab, NICE recommends that more research be done to invesigate whether patients who have received adjuvant trastuzumab should receive further biological response modifiers.

September 2014: The TAG noted NICE CG 81 (Update July 2014) – Advanced breast cancer: Diagnosis and treatment