Treatment
Figure 1. Algorithm for Patients with HER2+ Advanced Disease
Hormonal
therapy
2nd line trastuzumab
deruxtecan
1st line pertuzumab,
trastuzumab, taxane
a
OR
Endocrine therapy +
trastuzumab or lapatinib
OR
Endocrine therapy alone
1st line pertuzumab,
trastuzumab,
taxane
a
Patient diagnosed with
HER2+ advanced breast cancer
Received adjuvant trastuzumab
with or without pertuzumab?
Recurrence occurs
less than or equal
to 12 months?
Eligible for 1st line
HER2-targeted therapy
for HER2+ advanced
breast cancer?
Estrogen receptor
(ER)/progesterone
receptor (PgR)+?
Progression?
YES
YES
YES
NO
NO
NO
Monitor Monitor
Notes:
If patient is receiving HER2-targeted therapy and chemotherapy combinations, give chemotherapy
for 4–6 months or and/or to the time of maximal response, if low toxicity and no progression.
Continue HER2-targeted therapy aer stoppage of chemotherapy.
