They summed up their findings by explaining that not treating 1,000 low-risk women could result in five developing cardiac toxicities and 900 remaining alive at 3 years, but if treatment were given, the corresponding figures would be 26 and 933. "Therefore, careful attention is needed in patient selection, as the benefit of trastuzumab could be eroded by cardiac toxicity, particularly in low-risk patients or those at increased cardiovascular risk," they cautioned. They did note, however, that the cardiac toxicities might be reversible upon withdrawal of treatment. A limitation of their meta-analysis was its possible lack of generalizability, because the women in these studies tended to be younger, with a median age of 49, and otherwise healthier than those seen in clinical practice, having no cardiovascular problems at baseline. In addition, the inclusion of trials that were stopped early because interim analyses showed positive effects, with controls then being allowed to cross over to the treatment arm, could introduce bias. They recommended that all data from randomized trials of trastuzumab be published to help clarify the risks and benefits of the treatment and suggested that a meta-analysis be done for individual patient data. Primary source: Cochrane Database of Systematic Reviews Source reference: Moja L, et al “Trastuzumab containing regimens for early breast cancer” Cochrane Database Syst Rev 2012; DOI: 10.1002/14651858.CD006243.pub2.