In a recent randomized phase III trial evaluating the efficacy of dual targeted trastuzumab and lapatinib treatments in early-stage HER2 positive breast cancer, the North American Breast Cancer Group (NABCG) and the Breast International Group (BIG) found no significant statistical advantage in invasive disease free survival over single agent trastuzumab treatment alone in an 8000 patient population size [25,44]. This evidence concerns the gene ERBB2 and breast carcinoma.