207_Combined course Presentations
HER2 positive
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
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]* 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]* Extended adjuvant therapy with neratinib after one year of trastuzumab may reduce recurrence in ER positive subgroup*.
pT1 b,c node negative
Chemotherapy plus trastuzumab Consider paclitaxel plus one year trastuzumab without anthracyclines
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
Higher T or N stage
As above plus endocrine therapy appropriate to menopausal status
ER positive & HER2-positive
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