152 / 1851
HER2 positive
29
Subtypes according to clinical-pathological
and genomic risk assessment
Treatment recommendation
De-escalation
Escalation
ER negative & HER2-positive
pT1a node negative
No systemic therapy
No systemic therapy
pT1 b,c node negative
Chemotherapy plus trastuzumab Consider paclitaxel plus one
year trastuzumab without
anthracyclines
Dual blockade with pertuzumab and
trastuzumab improves outcome
among patients who are at higher risk
for relapse because of lymph-node
involvement or hormone-receptor
negativity [92]*
Higher T or N stage
Neoadjuvant therapy for stage II or
III is the preferred initial treatment
approach.
Anthracycline followed by taxane
with concurrent trastuzumab
continued to 12 months
Patients may be treated with
TCH regimen
Dual anti-HER2 therapy with
pertuzumab and trastuzumab with
chemotherapy as the preferred option
in the neoadjuvant setting
Dual blockade with pertuzumab and
trastuzumab improves outcome
among patients who are at higher risk
for relapse because of lymph-node
involvement or hormone-receptor
negativity [92]*
ER positive & HER2-positive
As above plus endocrine therapy
appropriate to menopausal status
Extended adjuvant therapy with
neratinib after one year of
trastuzumab may reduce recurrence in
ER positive subgroup*.