HER2+, ER+, PgR+
First-Line
Recommendation 6.0
➤ If a patient's cancer is hormone receptor-positive and HER2-positive,
clinicians may recommend either:
Recommendation 6.0.1
➤ HER2-targeted therapy plus chemotherapy. (Strong
recommendation; EB-H)
Recommendation 6.0.2
➤ Endocrine therapy plus trastuzumab or lapatinib (in selected cases).
(Strong recommendation; EB-M)
Recommendation 6.0.3
➤ Endocrine therapy alone (in selected cases). (Weak recommendation;
EB-I)
Endocrine Therapy Sequencing
Recommendation 7.0
➤ If the patient has started with a HER2-positive targeted therapy and
chemotherapy combination, clinicians may add endocrine therapy to
the HER2-targeted therapy when chemotherapy ends and/or when the
cancer progresses. (Weak recommendation; IC-Ins)
First-Line Endocrine Therapy
Recommendation 8.0
➤ In special circumstances, such as low disease burden, the presence
of co-morbidities (contradictions to HER2-targeted therapy such as
congestive heart failure), and/or the presence of a long disease free-
interval, clinicians may offer first-line endocrine therapy alone. (Weak
recommendation; IC-Ins)
Qualifying Statement: Although the clinician may discuss using endocrine therapy with
or without HER2-targeted, the majority of patients should still receive chemotherapy plus
HER2-targeted therapy.
