Key Points
➤ Human epidermal growth factor receptor 2 (HER2)-targeted therapy is
recommended for patients with HER2-positive advanced breast cancer,
except for those with clinical congestive heart failure or significantly
compromised left ventricular ejection fraction, who should be evaluated on
a case-by-case basis.
HER2+
First-Line
Recommendation 1.0
➤ Clinicians should recommend HER2-targeted therapy-based combinations
for first-line treatment, except for highly selected patients with estrogen
receptor-positive (ER+) or progesterone receptor-positive (PgR+) and
HER2-positive disease for whom clinicians may use endocrine therapy
alone. (Strong recommendation; EB-H)
Recommendation 1.1
➤ Clinicians should recommend the combination of trastuzumab,
pertuzumab, and a taxane for first-line treatment, unless the patient has a
contraindication to taxanes. (Strong recommendation; EB-B-H)
Second-Line
Recommendation 2.0
➤ If a patient's HER2-positive advanced breast cancer has progressed
during or after first-line HER2-targeted therapy, clinicians should
recommend second-line HER2-targeted therapy-based treatment. (Strong
recommendation; EB-H)
Recommendation 2.1 (updated)
➤ If a patient's HER2-positive advanced breast cancer has progressed during
or after first-line HER2-targeted therapy (and the patient has not received
trastuzumab deruxtecan), clinicians should recommend trastuzumab
deruxtecan as a second-line treatment. (Strong recommendation; EB-B-M)
Third-Line
Recommendation 3.0
➤ If a patient's HER2-positive advanced breast cancer has progressed
during or after second-line or greater HER2-targeted treatment, clinicians
should recommend third-line or greater-line HER2-targeted therapy-based
treatment. (Moderate recommendation; EB-I)
Treatment
