Treatment
➤ Overall, there are a lack of head-to-head trials, therefore there is
insufficient evidence to recommend one regimen over another. The
patient and clinician should discuss differences in treatment schedules,
routes, and toxicities during the decision-making process.
Options include the following:
Recommendation 3.1 (updated)
➤ If a patient's HER2-positive advanced breast cancer has progressed during
or after second-line or greater HER2-targeted treatment and the patient
has already received pertuzumab and trastuzumab deruxtecan, clinicians
should recommend third-line or greater HER2-targeted therapy-based
treatment.
Recommendation 3.1.1 (updated)
➤ If a patient has not received trastuzumab emtansine (T-DM1) in second-
line, should offer T-DM1 regimen. (Strong recommendation; EB-B-H)
Recommendation 3.1.2 (updated)
➤ May offer tucatinib combined with trastuzumab and capecitabine. (Strong
recommendation; EB-B-M)
Recommendation 3.1.3 (updated)
➤ May offer trastuzumab deruxtecan. (Strong recommendation; EB-B-M)
Recommendation 3.1.4 (updated)
➤ May offer neratinib combined with capecitabine. (Weak recommendation;
EB-B-M)
Recommendation 3.1.5
➤ May offer lapatinib and trastuzumab. (Weak recommendation; EB-B-M)
Recommendation 3.1.6
➤ May offer lapatinib and capecitabine. (Weak recommendation; EB-B-M)
Recommendation 3.1.7
➤ May offer other combinations of chemotherapy and trastuzumab. (Weak
recommendation; EB-B-M)
Recommendation 3.1.8 (updated)
➤ May offer margetuximab plus chemotherapy. (Weak recommendation;
EB-B-M)
