HER2-positive breast cancer, stage II-III

HER2-positive breast cancer →

Chemotherapy with two HER2 antibodies for about four months before surgery; what the surgeon finds decides the next year of anti-HER2 treatment (antibodies alone, or the ADC T-DM1 if cancer remained).

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Typical sequence for stage II-III (operable) disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

1. Diagnosis and staging
weeks 0-4
Core biopsy with HER2 by IHC and in-situ hybridisation; imaging; echocardiogram before anti-HER2 therapy.
Histopathology & immunohistochemistry Mammography & tomosynthesis MRI
Source
2. Neoadjuvant chemotherapy + trastuzumab + pertuzumab
weeks 2-20
Six 3-week cycles of docetaxel and carboplatin with trastuzumab and pertuzumab (TCHP).
DocetaxelCarboplatinTrastuzumabPertuzumabMonoclonal antibodies Cytotoxic chemotherapy
Source
3. Surgery
weeks 20-26
Breast surgery with sentinel node biopsy; the pathology report shows whether invasive cancer remains.
Sentinel lymph node biopsy
Source
Decision: Was there a pathological complete response?
- pCR: finish the year with trastuzumab and pertuzumab
- Residual invasive disease: switch to T-DM1 for 14 cycles (KATHERINE)
4. Adjuvant anti-HER2 therapy
weeks 23-65
pCR: trastuzumab and pertuzumab to complete one year of antibody therapy. Residual disease: trastuzumab emtansine (T-DM1) for 14 cycles (KATHERINE), about 42 weeks.
TrastuzumabPertuzumabTrastuzumab emtansineAntibody-drug conjugate (ADC)
Source
5. Radiotherapy
weeks 23-29 (alongside the previous phase)
Given during antibody therapy after breast conservation or node-positive mastectomy.
IMRT / IGRT (modern external beam)
Source
6. Endocrine therapy (if also HR-positive)
from week 57, continues for years
Tamoxifen or an aromatase inhibitor for 5-10 years when the tumour is also hormone receptor positive.
TamoxifenLetrozole (and other aromatase inhibitors)Endocrine therapy (SERMs, AIs, SERDs)
Source
7. Surveillance
from week 317, continues for years
Clinic visits every 3-6 months for 3 years then yearly; annual mammography; cardiac monitoring during antibody therapy.
Source

Sources

Phase by phase

1. Diagnosis and staging

weeks 0-4

Core biopsy with HER2 by IHC and in-situ hybridisation; imaging; echocardiogram before anti-HER2 therapy.

Histopathology & immunohistochemistry Mammography & tomosynthesis MRI

Source

2. Neoadjuvant chemotherapy + trastuzumab + pertuzumab

weeks 2-20

Six 3-week cycles of docetaxel and carboplatin with trastuzumab and pertuzumab (TCHP).

DocetaxelCarboplatinTrastuzumabPertuzumabMonoclonal antibodies Cytotoxic chemotherapy

Source

3. Surgery

weeks 20-26

Breast surgery with sentinel node biopsy; the pathology report shows whether invasive cancer remains.

Sentinel lymph node biopsy

Source

Decision: Was there a pathological complete response?

pCR: finish the year with trastuzumab and pertuzumab
Residual invasive disease: switch to T-DM1 for 14 cycles (KATHERINE)

4. Adjuvant anti-HER2 therapy

weeks 23-65

pCR: trastuzumab and pertuzumab to complete one year of antibody therapy. Residual disease: trastuzumab emtansine (T-DM1) for 14 cycles (KATHERINE), about 42 weeks.

TrastuzumabPertuzumabTrastuzumab emtansineAntibody-drug conjugate (ADC)

Source

5. Radiotherapy

weeks 23-29 (alongside the previous phase)

Given during antibody therapy after breast conservation or node-positive mastectomy.

IMRT / IGRT (modern external beam)

Source

6. Endocrine therapy (if also HR-positive)

from week 57, continues for years

Tamoxifen or an aromatase inhibitor for 5-10 years when the tumour is also hormone receptor positive.

TamoxifenLetrozole (and other aromatase inhibitors)Endocrine therapy (SERMs, AIs, SERDs)

Source

7. Surveillance

from week 317, continues for years

Clinic visits every 3-6 months for 3 years then yearly; annual mammography; cardiac monitoring during antibody therapy.

Source