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By Regina H. DeFrina

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It is hypothesized that prior to the availability of trastuzumab, control of systemic disease was the major limiting factor in the survival of women with HER2-positive, metastatic breast cancer. Since then, a number of investigators have described an increase in the proportion of patients dying of CNS disease progression, compared with historical estimates. 36 Myra F. Barginear and Daniel R. Budman Figure 5. Axial images of a brain magnetic resonance imaging (MRI) study demonstrating an intracerebral metastasis in a patient with HER2-positive breast cancer.

As a final point, in regards to neo-adjuvant therapy, a study conducted by Ellis et al in post-menopausal women who were ER-positive and/or PR-positive on pre-treatment biopsy were randomly assigned to either letrozole or tamoxifen [137]. In 237 women a biopsy was also available for central testing of HER2 and EGFR. 095). 004). 0004). 078). Studies such as that reported by Ellis et al concentrate on whether de novo overexpression of HER2 contributes to tamoxifen resistance. However many tumors are not resistant from the outset but rather exhibit an initial response before acquiring resistance to treatment.

In the second trial, known as the EGF30008 study, the efficacy of the combination of lapatinib plus letrozole (Femara® Novartis) compared with letrozole plus placebo in patients with ER-positive metastatic breast cancer was assessed [72]. 0 months. As a final point, in regards to neo-adjuvant therapy, a study conducted by Ellis et al in post-menopausal women who were ER-positive and/or PR-positive on pre-treatment biopsy were randomly assigned to either letrozole or tamoxifen [137]. In 237 women a biopsy was also available for central testing of HER2 and EGFR.

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