While Herceptin has become standard treatment for women with HER2-positive malignancies, the timing of its use is still much in debate. Editorials accompanying Gianni's study took opposing views, with Finnish researcher Heikki Joensuu contending that administering Herceptin simultaneously with chemotherapy might be more effective.

Belgian researcher Evandro de Azambuja, however, argued that the simultaneous treatments would significantly increase the risk of heart damage, which can be a side effect of both Herceptin and a class of standard chemotherapy drugs called anthracyclines.

"I think that both views are respectable, but not necessarily so diverging as they look at first glance," Gianni said. "One should simply consider that the ideal approach can well be that of combining administration of trastuzumab with chemotherapy . . . but avoiding anthracyclines does not mean to avoid combined chemotherapy. Anthracyclines contribute an added benefit that should be thoroughly weighted against the risk of cardiac events before dismissing the combination just as too toxic."

Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital in New York City, said the study's results met her expectations.

"It's confirmation of the fact that Herceptin is extremely effective in patients who show this protein," said Cassell, who noted that oncologists at her hospital typically administer Herceptin for one year after chemotherapy ends. "It is something routinely being used."

Gianni and Cassell agreed that more research needs to focus on whether Herceptin use should be extended to further improve its effectiveness.

"For how long the trastuzumab should be given is really unclear and difficult to test, but in my view will need to be addressed," Gianni said. "The most important message is that we still are and will continue to learn from continuous follow up of studies . . . about [its] optimal use."'/>"/>

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