Background Adjuvant trastuzumab significantly improves outcomes for patients with HER2-positive early breast cancer. The standard treatment duration is 12 months but shorter treatment could provide similar efficacy while reducing toxicities and cost. We aimed to investigate whether 6-month adjuvant trastuzumab treatment is noninferior to the standard 12-month treatment regarding disease-free survival. Methods This study is an open-label, randomised phase 3 non-inferiority trial. Patients were recruited from 152 centres in the UK. We randomly assigned patients with HER2-positive early breast cancer, aged 18 years or older, and with a clear indication for chemotherapy, by a computerised minimisation process (1:1), to receive either 6-month or 12-month trastuzumab delivered every 3 weeks intravenously (loading dose of 8 mg/kg followed by maintenance doses of 6 mg/kg) or subcutaneously (600 mg), given in combination with chemotherapy (concurrently or sequentially). The primary endpoint was disease-free survival, analysed by intention to treat, with a non-inferiority margin of 3% for 4-year disease-free survival. Safety was analysed in all patients who received trastuzumab. This trial is registered with EudraCT (number 2006-007018-39), ISRCTN (number 52968807), and ClinicalTrials.gov (number NCT00712140).

Progress in biomarkers research has resulted in increasing awareness of the heterogeneity of breast cancer. The identification of subtypes with different clinical behavior and the possibility of using targeted therapy in specific subgroup of patients (eg, those with tumors overexpressing HER2) raise expectations for increasing personalization of treatment. However, there is a widening gap between scientific discoveries and practical application in everyday practice: too many patients are still being managed based only on traditional clinical and pathologic parameters, because of lack of access to up to date technology-such as gene profiling, or cell proliferation assays-in many cancer centers in the United Kingdom. In this article, we provide some examples of this contrast, drawn from the literature and from our own clinical experience in South West Wales, and discuss possible solutions.

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We report the case of a 63-year-old male with an inoperableT4N1 adenocarcinoma of colon, K-RAS mutant, who received first line chemotherapy with capecitabine and oxaliplatin. A CT scan following 4 cycles demonstrated progressive disease, and second line therapy with capecitabine, irinotecan and bevacizumab was commenced. CT scans at 3 and 6 months during this treatment regime demonstrated radiologically stable disease, and therefore the treatment was continued. The patient developed nasal septal perforation, a rare but recognised complication of bevacizumab therapy, which was managed conservatively. Here we highlight that no consensus exists on whether bevacizumab should be continued in this situation. After a detailed discussion about the risks and benefits, this patient continued on with the same therapeutic regime. However, eight weeks later, this patient then developed a localised tumour perforation, necessitating an emergency admission to his local hospital. We recommend caution in continuing bevacizumab in patients with colorectal cancer following a nasal septal perforation and advise a detailed discussion of risk with the patient, especially when the primary tumour remains in-situ.