NICE clinical guideline 80 (Breat cancer: early and locally advanced, published in February 2009) updates the recommendations contained in this appraisal.
Trastuzumab treatment should be offered as an option for women with early-stage HER2-positive breast cancer after they have had surgery and chemotherapy (and sometimes radiotherapy).
Trastuzumab should be given once every 3 weeks for 12 months, or until the breast cancer comes back, whichever is sooner.
Trastuzumab treatment has been associated with heart problems. Before trastuzumab is prescribed a woman should have tests to check how well her heart is working. The tests should be repeated every 3 months during treatment. If a woman develops heart problems while taking trastuzumab her treatment will be stopped.
Trastuzumab should not be offered to women with certain heart problems or with high blood pressure that is not well controlled with drugs or other treatment.
It has been brought to our attention that this guidance contained an error in section 1.3, where it stated that:
‘Cardiac functional assessments should be repeated every 3 months during trastuzumab treatment. If the LVEF drops by 10% from baseline and to below 50% then trastuzumab treatment should be suspended…?
This has now been amended so that it follows more closely the SPC for trastuzumab, as follows:
‘Cardiac functional assessments should be repeated every 3 months during trastuzumab treatment. If the LVEF drops by 10 percentage (ejection) points or more from baseline and to below 50% then trastuzumab treatment should be suspended…?
Electronic versions of the guidance have been amended below. Printed copies of the amended quick reference guide will be available shortly from the NHS Response Line; telephone 0870 1555 455 and quote reference number N1111.
Update to guidance
CG80 Early and locally advanced breast cancer updates the recommendations contained in this appraisal. NICE and the Department of Health are currently reviewing the future position on updating technology appraisals within clinical guidelines, with particular reference to implications for the funding direction on technology appraisals. In the meantime, the technology appraisal guidance remains available and should continue to be followed. The statutory funding direction remains in place for the recommendations contained in the technology appraisal guidance.