HER2 3+

Clinical Practice Guidelines Early Breast Cancer ESMO 2023

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Purple: general categories or stratification; turquoise: combination of treatments or other systemic treatments; white: other aspects of management; blue: systemic anticancer therapy; dashed line: optional recommendation. c, clinical; CISH, chromogenic in situ hybridisation; ChT, chemotherapy; EBC, early breast cancer; EMA, European Medicines Agency; ET, endocrine therapy; FDA, Food and Drug Administration; HER2, human epidermal growth factor receptor 2; HP, trastuzumab–pertuzumab; HR, hormone receptor; MCBS, ESMO-Magnitude of Clinical Benefit Scale; N, node; p, pathological; pCR, pathological complete response; RT, radiotherapy; T, tumour; T-DM1, trastuzumab emtansine.

  • aTumours <2 cm can be considered for neoadjuvant therapy.
  • bESMO-MCBS v1.1115 was used to calculate scores for new therapies/indications approved by the EMA or FDA. The scores have been calculated and validated by the ESMO-MCBS Working Group and reviewed by the authors (https://www.esmo.org/guidelines/esmo-mcbs/esmo-mcbs-evaluation-forms).
  • cESCAT score I-A if HER2 gene amplification by FISH/CISH. ESCAT scores apply to alterations from genomic-driven analyses only. These scores have been defined by the guideline authors and assisted as needed by the ESMO Translational Research and Precision Medicine Working Group.114 See Supplementary Table S7, available at Annals of Oncology online, for more information on ESCAT scores.

Management of early TNBC (figure 7)