| Consensus Statement | Quality of Evidence | Strength of Rec. | Key Ref |
|---|---|---|---|
| 1. For patients with HER2-positive EBC who have residual invasive disease following preoperative therapy, Trastuzumab deruxtecan (T-DXd) is preferred adjuvant option than T-DM1 (for inoperable cT4 N0-3, cT1-3 N2-3 or operable cancer with axillary node positive following preoperative therapy)* | I | A | 1 |
| 2. For patients who do not achieve a pathological complete response (pCR) following HER2-targeted neoadjuvant therapy, adjuvant T-DM1 x 14 is the preferred regimen. For patients who are unable to tolerate T-DM1, trastuzumab with or without pertuzumab (IV or SC) may be continued for 1 year as an alternative treatment. | I | A | 2 |
| 3. In patients who achieve pCR, adjuvant trastuzumab with or without pertuzumab (IV or SC) to complete a year of HER2-targeted therapy is the standard of care. For patients with positive nodal disease at initial presentation, trastuzumab plus pertuzumab (IV or SC) is the preferred adjuvant HER2-targeted regimen. | 1 | A | 3,4,5 |
* There is currently no evidence supporting or opposing the benefit of adjuvant T-DXd for patients who have residual disease after preoperative T-DXd
References
- Loibl S, et al.Trastuzumab Deruxtecan in Residual HER2-Positive Early Breast Cancer. N Engl J Med. 2026 Feb 26;394(9):845-857.
- Gunter von Minckwitz, et al. N Engl J Med. 2019;380:617-628
- AGO guideline 2025 version
- S. Loibl, et al. Ann Oncol. 2023
- NCCN Guidelines Breast Cancer. Version 3.2026