Personalized Selection of HER2+ Breast Cancer Therapies

Treatment selection in HER2-positive breast cancer is increasingly guided by disease stage, risk profile, and patient-specific factors. In early breast cancer, clinicians carefully weigh neoadjuvant versus adjuvant therapy, often starting with a taxane-based and dual HER2 antibody regimen, reserving antibody-drug conjugates (ADCs) like T-DXd for high-risk patients or those with residual disease. In the metastatic setting, therapy sequencing is informed by prior treatments, disease burden, and biomarker status, balancing efficacy with tolerability. Clinical criteria for ADC eligibility include HER2 expression levels, prior response to HER2-directed therapy, and organ function. Differentiating among ADCs involves considering factors such as mechanism of action, payload, toxicity profile, and trial evidence. Personalized sequencing and thoughtful ADC integration across both early and metastatic settings allow for optimized outcomes while minimizing unnecessary toxicity.