However, the SYSUCC-002 trial has limitations in that the hazard ratio upper bound defining non-inferiority was rather modest (1.35) and the trial did not incorporate pertuzumab in the first-line HER2+ metastatic setting, which is the current standard of care (based upon a large and highly significant OS advantage in first-line HER2+ metastatic disease in the CLEOPATRA trial84) and only a minority of patients in SYSUCC-002 were assigned to taxane chemotherapy in the control arm. This evidence concerns the gene ERBB2 and metastatic neoplasm.