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Early-stage HER2+ Breast Cancer
Early stage
HER2+
< 2 cm and
node negative
Surgery
pT1 pN0
Weekly paclitaxel
+ trastuzumab × 12
Tolaney, NEJM 2015
Complete 1 year
of trastuzumab
pT2 or
pN1+
Adjuvant chemo + trastuzumab
± pertuzumab
APHINITY ↗
≥ 2 cm or
node positive
Neoadjuvant chemo +
trastuzumab + pertuzumab
NeoSphere / APHINITY ↗
Surgery
pCR
Complete 1 yr trastuzumab
± pertuzumab
APHINITY ↗
Consider neratinib
× 1 year
ExteNET (HR+ / N+) ↗
Residual
disease
T-DM1 × 14
(complete 1 year)
KATHERINE ↗
Consider neratinib
× 1 year
ExteNET (HR+ / N+) ↗