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HER2-positive breast cancer caught early is usually cured. Chemotherapy with the antibodies trastuzumab and pertuzumab comes before surgery; if the tumour has gone by then, antibodies alone finish the year, and if cancer remains, trastuzumab emtansine or trastuzumab deruxtecan take over. Small tumours get a gentler regimen, and trials now ask how much treatment can be left out.
A year of trastuzumab is the foundation. HERA, NSABP B-31 and NCCTG N9831, reported together in 2005, showed that adding trastuzumab to adjuvant chemotherapy cut deaths by about a third, with ten-year overall survival of 84 percent against 75.2 percent in the joint American analysis. PERSEPHONE found six months almost as good as twelve (four-year disease-free survival 89.4 against 89.8 percent) with half the cardiac toxicity, but twelve months remains the standard. For tumours of 3 cm or less without node involvement, the single-arm APT study of twelve weeks of paclitaxel with a year of trastuzumab gave 93 percent seven-year disease-free survival and became the standard for stage I disease without a randomised trial.
For stage II and III disease treatment moved before surgery, where pathological complete response predicts cure and guides what follows. NeoSphere showed that pertuzumab added to trastuzumab and docetaxel raises the complete response rate, and TRAIN-2 (438 patients) showed that carboplatin and paclitaxel with both antibodies matched an anthracycline regimen (complete response 67 against 68 percent) with less cardiac damage, so anthracycline-free regimens became usual. KRISTINE (444 patients) tested replacing chemotherapy with trastuzumab emtansine plus pertuzumab and found fewer complete responses (44.4 against 55.7 percent) and more progression before surgery, a warning against de-escalating on antibody-drug conjugates alone. KATHERINE (1,486 women with residual invasive disease) showed that fourteen cycles of trastuzumab emtansine instead of trastuzumab halved recurrence (three-year invasive disease-free survival 88.3 against 77.0 percent) and improved seven-year overall survival (89.1 against 84.4 percent), and APHINITY (4,805 women) showed adjuvant pertuzumab adds a few points of invasive disease-free survival in node-positive disease and nothing in node-negative disease.
Trastuzumab deruxtecan is now reshaping both ends. DESTINY-Breast05 (1,635 women with residual disease) showed it beats trastuzumab emtansine, with three-year invasive disease-free survival of 92.4 against 83.7 percent (hazard ratio 0.47), and DESTINY-Breast11 (927 women) showed trastuzumab deruxtecan followed by taxane, trastuzumab and pertuzumab before surgery gives more complete responses than dose-dense anthracycline chemotherapy (67.3 against 56.3 percent); the FDA approved both indications in 2026. In the other direction, PHERGain used an early PET scan to identify women who could be cured with antibodies and no chemotherapy at all, with 95.4 percent three-year invasive disease-free survival in the adapted arm and about a third spared chemotherapy. Who can safely skip chemotherapy, whether interstitial lung disease is acceptable in a curative setting, and how hormone receptor-positive HER2-positive tumours should be treated differently are the open questions.
Around 15 to 20 percent of breast cancers overexpress HER2 and most are diagnosed at an operable stage; once the subtype with the worst outlook, it now has some of the highest cure rates after a year of HER2-directed therapy.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), Breast cancer (all types), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Surgery first, then twelve weeks of paclitaxel with a year of trastuzumab (APT).
Carboplatin, a taxane, trastuzumab and pertuzumab for six cycles without an anthracycline (TRAIN-2), or trastuzumab deruxtecan followed by taxane, trastuzumab and pertuzumab (DESTINY-Breast11).
Trastuzumab, with pertuzumab in node-positive disease, to complete one year (APHINITY, HERA); endocrine therapy if hormone receptor-positive.
Trastuzumab deruxtecan (DESTINY-Breast05) or trastuzumab emtansine for fourteen cycles (KATHERINE).
Breast conservation or mastectomy with sentinel node biopsy, radiotherapy by stage, and echocardiography every three months during trastuzumab.
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HER2-positive breast cancer is now routinely treated before surgery so that the pathology result can guide what comes after: patients with no residual cancer continue trastuzumab (with or without pertuzumab), while those with residual disease switch to T-DM1. This model of using the tumour's response as a test has since been copied in triple-negative and other cancers.
Anthracycline-free carboplatin-taxane chemotherapy with dual HER2 blockade is a standard neoadjuvant regimen, sparing patients cardiac risk without losing efficacy.
Dual HER2 blockade after surgery is reserved for node-positive or otherwise higher-risk disease, where the benefit is real but small; node-negative patients can be spared the extra drug.
Women with small HER2-positive tumours can avoid anthracyclines and multi-agent chemotherapy; the APT regimen is a guideline standard for stage I HER2-positive disease.
Query for this cancer: (TITLE:"Early HER2-positive breast cancer" OR ABSTRACT:"Early HER2-positive breast cancer" OR TITLE:"Stage I to III HER2-positive breast cancer" OR ABSTRACT:"Stage I to III HER2-positive breast cancer" OR TITLE:"Operable HER2-positive breast cancer" OR ABSTRACT:"Operable HER2-positive breast cancer" OR TITLE:"HER2-positive breast cancer treated with curative intent" OR ABSTRACT:"HER2-positive breast cancer treated with curative intent") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Early HER2-positive breast cancer, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
Interstitial lung disease in 10-15%: hold for any respiratory symptom and image; permanently discontinue for grade 2 or above. Moderately emetogenic: three-drug prophylaxis.
Dose by Calvert formula using GFR (see the calculators).
Do not give if bilirubin above ULN, or AST/ALT above 1.5 x ULN with alkaline phosphatase above 2.5 x ULN (treatment-related deaths).
See all on the product pages:CarboplatinDocetaxelPaclitaxel / nab-paclitaxelTrastuzumab deruxtecanTrastuzumab emtansine·Printable cards in the navigator
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
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