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Strategies for Adjuvant Treatment in HER2+ Early-Stage Breast Cancer

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This activity is available for 0.50 CME/CE credit(s).

Released: October 13, 2026

Expiration: April 12, 2027

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This activity reviews evolving evidence and clinical decision-making for adjuvant therapy in patients with HER2-positive early breast cancer (EBC), with a focus on tailoring treatment according to pathologic response, baseline stage, residual disease burden, and recurrence risk. Key data include long-term outcomes from APHINITY and KATHERINE, emerging evidence from DESTINY-Breast05 comparing adjuvant trastuzumab deruxtecan (T-DXd) with trastuzumab emtansine (T-DM1) in patients with high-risk residual disease, and considerations related to CNS recurrence, treatment toxicity, and reassessment of HER2 status after neoadjuvant therapy. The activity also addresses extended adjuvant neratinib, endocrine therapy selection in HR-positive/HER2-positive disease, and the evolving choice between neoadjuvant and adjuvant T-DXd, highlighting how these data may inform individualized treatment selection and risk-adapted management in clinical practice.

Adrienne G. Waks
Adrienne G. Waks, MD
Adjuvant Tx in HER2 EBC

Pre Assessment

Assess your current knowledge and clinical approach before beginning your video.
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1.

How many people with breast cancer do you provide care for in a typical month?

2.

For those who practice in academic or community settings, please indicate your practice setting:

3.

A 58-year-old woman presents with operable, HER2-positive (IHC 3+), HR-negative breast cancer, staged as cT2N1M0. She receives 6 cycles of neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP), followed by surgery. Pathology shows a 1.2-cm residual invasive tumor and residual disease in 2 axillary lymph nodes (ypT1cN1a). She has normal cardiac function and no history of interstitial lung disease.

Which adjuvant regimen would be most appropriate for this patient?

4.

A 50-year-old woman with node-negative (cT2N0), hormone receptor–negative, HER2-positive stage II breast cancer receives neoadjuvant TCHP. At surgery, she has 8 mm of residual invasive disease in the breast and no involved lymph nodes. You plan to treat the patient with T-DM1. A pathology report reveals the residual tumor is now HER2 negative (IHC 0). How do you proceed with adjuvant treatment?

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