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

29