More options for adjuvant treatment of HER2-positive breast cancer: How to choose wisely?

Human epidermal growth factor receptor 2-positivity (HER2) has a prognostic and predictive role in breast cancer. Trastuzumab, an anti-HER2 therapy, has a crucial role in a curative setting in Stage I, II and III breast cancer. In recent years, more anti-HER2 agents have been tested in clinical trials. Newer dosing strategies and combination approaches give us a plethora of options to treat a patient with early-stage and locally advanced breast cancer. It has led to the possibility of providing a risk-adapted treatment for patients with HER2-positive breast cancer. In order to reduce overtreatment and protect patients from adverse effects, a deescalation framework can be used in patients at lower risk for recurrence. Similarly, in those with greater risk for recurrence, escalation of therapy can be considered with the goal of achieving a cure. In this narrative review, we aim to provide a critical appraisal of the recent research findings in the management of early-stage and locally advanced breast cancer.