ERBB2 and metastatic neoplasm: However, the introduction of trastuzumab, a monoclonal antibody targeting the human epidermal growth factor 2 (HER2), in 2010 has led to improved survival rates in a subgroup of patients, and second-line treatment with paclitaxel and ramucirumab showed superior survival compared with paclitaxel alone.36,37 The development of novel systemic therapies, such as targeted therapies, are reflected in our data by the increase of relative survival since approximately 2009 to 2013 for patients with metastatic disease, even though the proportion of patients receiving targeted therapy is small.