Dr Borgen on Matching Treatment to HER2 Biology in Early-Stage HER2-Positive Breast Cancer

“We have to think of early-stage HER2-positive invasive breast cancer as a spectrum of disease, and we need to begin to match the treatment [to] the HER2 [subtype] that’s in the patient in front of us.”

Patrick I. Borgen, MD, chair of the Department of Surgery and head of the Maimonides Breast Center at the Maimonides Cancer Center at Maimonides Medical Center, discussed treatment sequencing, the use of molecular assays such as HER2DX, and the challenge of consensus in early-stage HER2-positive breast cancer management.

Borgen’s insights were based on discussions from the 2026 Bridging the Gaps in Breast Cancer Meeting.

Borgen said that this meeting enables him to convey pertinent discussion points to his surgical oncology colleagues, including whether to operate first or give neoadjuvant therapy, what types of imaging are needed, how residual disease is interpreted, and how the axilla are managed. At Bridging the Gaps, experts debated several topics in early-stage HER2-positive disease, and controversies persisted even among those immersed in the field, he noted.

Early-stage HER2-positive disease encompasses different levels of HER2 expression and amplification, and therapy should be matched accordingly, Borgen explained. Strong HER2–overexpressing disease responds differently from disease with lower levels of HER2 expression and may not need agents as toxic as antibody-drug conjugates, he said. Assays such as HER2DX could change the landscape by informing both choice and sequencing of treatment, according to Borgen.

He pointed to the phase 2, single-arm APT trial (NCT00542451), in which paclitaxel plus trastuzumab (Herceptin) yielded some of the highest disease-free survival rates ever seen in breast cancer. These data willhelp determine which patients are candidates for a taxane plus trastuzumab; which would benefit from docetaxel, carboplatin, trastuzumab, and pertuzumab (Perjeta); and which would benefit from fam-trastuzumab deruxtecan-nxki (Enhertu), Borgen said. Predicting the class of HER2-positive disease that is present in each patient will be critical to future developments in this field, he added.