Treatments for HER2+ early breast cancer

If your early breast cancer is HER2 positive, you will usually have a combination of treatments, usually:

• neoadjuvant chemotherapy plus HER- targeted medication, then surgery and more HER2-targeted medications
• surgery followed by chemotherapy and HER2-targeted medication. 

Your treating team will talk to you about your options. The plan they recommend will consider your individual breast cancer and your preferences.

Chemotherapy

You may have:

• chemotherapy before surgery (called ‘neoadjuvant therapy’ or neoadjuvant treatment), with HER2 targeted therapy
• chemotherapy after surgery, with HER2-targeted therapy. This usually starts within 4 to 6 weeks after surgery, before radiotherapy. This is common for people with smaller tumours.

Read About chemotherapy.

HER2 targeted therapies

HER2 targeted therapies are drugs that attack cancer cells but mostly do not affect normal cells. They target breast cancer cells that carry the HER2 receptor or protein.

You may have this treatment before surgery, after surgery, or both.

Some studies have shown that having HER2 targeted therapy before surgery can be linked to better cancer survival rates for people with higher stage breast cancers.

Read about HER2 targeted therapies.

Trastuzumab (Herceptin and other brands)

The main HER2 targeted therapy is trastuzumab. The most common brand for trastuzumab is Herceptin. It works by attaching to the HER2 protein on the surface of some breast cancer cells. This stops the cells from dividing and growing.

Herceptin is usually given as an injection under the skin or as an IV (intravenous) injection.

Herceptin before surgery: for between 12 and 18 weeks.

Herceptin after surgery: often given with chemotherapy for 3 months, then continued alone for a total of 12 months.

Pertuzumab (Perjeta)

Pertuzumab (Perjeta) is another HER2 targeted therapy commonly used for the treatment of HER2 positive early breast cancer.

Perjeta before surgery: often given with trastuzumab and chemotherapy, for up to 6 cycles.

Perjeta after surgery: sometimes given after surgery with trastuzumab for 12 months in total.

Read more about Targeted therapies.

Surgery

You may have surgery first, or it may follow neoadjuvant therapy. Your breast surgeon will discuss these options with you:

• lumpectomy (‘breast conserving surgery’), which is usually followed by radiotherapy
• mastectomy (with or without immediate breast reconstruction).

To understand these options, go to Surgery options for breast cancer.

Your surgeon may refer you to a medical oncologist to discuss whether chemotherapy and HER2 targeted therapy before or after surgery is best for you.

Radiotherapy

If you have a lumpectomy, radiotherapy will be recommended as part of your treatment plan. This happens after surgery when you finish chemotherapy. You can have HER2 targeted therapy at the same time as radiotherapy.

The aim of radiotherapy is to kill any cancer cells that may be left in the breast and lymph nodes.

Hormone-blocking therapies

HER2-positive breast cancer can also be hormone receptor positive (‘triple positive’). In this case, you will usually be offered a hormone-blocking therapy.

This often starts after you finish chemotherapy and radiotherapy. You can have hormone-blocking therapy and HER2-targeted therapy at the same time.

Read About hormone-blocking therapy.

Research and clinical trials for HER2-positive breast cancer

Clinical trials have shown that chemotherapy given with HER2 targeted therapies is very effective for HER2-positive breast cancer.

Current trials are testing HER2 targeted drugs in combination with other treatments such as CDK4/6 inhibitors. These may lead to new treatments and better outcomes.

Ask your doctor about any clinical trials that may be suitable for you.

Support for treatment decisions

Some people find it helpful to connect with others who have the same type or subtype of breast cancer. Our Online Network is a safe and supportive place to find people facing the same decisions.

Our Helpline is also available on 1800 500 258 between 9.00 am and 5.00 pm AEST Monday to Friday. Contact us if you have questions about your diagnosis or treatment.