In a study of resistance to trastuzumab in patients with early-stage human epidermal growth factor receptor 2-positive (HER2(+)) breast cancer, it was found that the high expression of alpha smooth muscle actin (a-SMA) in leukocytes and stromal compartments is associated with shorter DFS; a-SMA can be used as a new biomarker of trastuzumab resistance, providing new ideas for solving the problem of trastuzumab resistance [42]. This evidence concerns the gene ERBB2 and breast carcinoma.