Women receiving
neoadjuvant systemic therapy for primary operable or inoperable
breast cancer can potentially benefit in a number of ways, but the main advantage, which has been consistently demonstrated, is improved tumour resectability. Given the improvement in outcomes with the adjuvant use of
trastuzumab in patients with early-stage
breast cancer positive for the
human epidermal growth factor receptor 2 (HER2), questions have been raised about the use of
trastuzumab in the neoadjuvant setting. The present paper reviews the currently available data and outlines suggestions from a panel of Canadian oncologists about the use of
trastuzumab and other HER2-targeted agents in the neoadjuvant setting.The panel focussed on the use of
trastuzumab and other HER2-targeted agents as
neoadjuvant therapy in primary operable, locally advanced, and
inflammatory breast cancer; and possible choices of chemotherapeutic regimens with
trastuzumab.The suggestions described here will continue to evolve as data from current and future trials with
trastuzumab and other HER2-targeted agents emerge.