NICE has recommended that trastuzumab (Herceptin) is used in combination with paclitaxel for women with tumours with excessive human epidermal growth factor receptor 2 (HER2) at levels of 3+ who have not had chemotherapy for metastatic breast cancer and for whom anthracycline treatment is inappropriate.
Trastuzumab by itself is recommended for women with tumours with excessive HER2 at levels of 3+ who have had at least two chemotherapy treatments for metastatic breast cancer. Previous chemotherapy must have included at least an anthracycline drug and a taxane drug where these treatments are appropriate. It should also have included hormonal therapy in patients sensitive to oestrogen.
The level of HER2 protein in the body should be assessed by a clinician using appropriate standards and methods.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.