The recent development of targeted therapies using monoclonal antibodies has added new dimensions to breast cancer treatment. Trastuzumab has been added to the regimens that contain chemotherapeutic agents, which has improved the clinical outcomes of patients in both the adjuvant and metastatic settings. However, trastuzumab resistance, both de novo and acquired, continues to be problematic. There have been scattered studies reporting ERBB2 gene mutation, but nothing is currently known about the ERBB2 binding site mutations. In the current study, we examined the ERBB2 juxtamembrane domain trastuzumab binding site for mutations in invasive breast cancers overexpressing ERBB2. Pure tumor cells of 54 breast cancer patients were procured using laser capture microdissection. Two polymerase chain reaction primer pairs were designed to amplify the trastuzumab binding site sequence. The polymerase chain reaction product was sequenced. Standard clinicopathological data were recorded. For the 54 patients, there was one (2%) case that showed missense point mutation in exon 17 (H559A). There were nine patients treated with trastuzumab in the metastatic setting, none of which had gene mutation. Therefore, we conclude that ERBB2 juxtamembrane domain (trastuzumab binding site) gene mutation is a rare event in breast cancer. Although it is unclear whether this substitution would result in trastuzumab target therapy resistance, this would not account for the relatively high frequency of this resistance encountered clinically. Increasingly, management decisions regarding whether oncologists should prescribe adjuvant treatment are being based on the biology of the patient's tumor, with a consideration of the hormone receptor status, 4 and more recently, with the assessment of ERBB2. 5 The identification of the amplification of ERBB2 gene and the overexpression of its protein product has resulted in targeted monoclonal antibody-based therapy. 6,7 Preclinical studies indicate synergistic anti-tumor activity when trastuzumab is combined with a number of anti-cancer drugs. Additive cytotoxic interactions between trastuzumab and other agents, including paclitaxel,