Advancing HER2-low breast cancer management: enhancing diagnosis and treatment strategies


  • Simona Borstnar
  • Ivana Božović -Spasojević Institute for Oncology and Radiology of Serbia, Medical Faculty, University of Belgrade, Serbia
  • Ana Cvetanović Department of oncology, Medical Faculty University of Niš; Clinic of On-ology, University Clinical Centre Niš, Serbia
  • Natalija Dedić Plavetić University Hospital Centre Zagreb, School of Medicine, University of Za-greb, Croatia
  • Assia Konsoulova National Cancer Hospital, Sofia, Bulgaria
  • Erika Matos Institute of Oncology Ljubljana
  • Lazar Popović Oncology Institute of Vojvodina, Faculty of Medicine, University Novi Sad, Novi Sad, Serbia
  • Savelina Popovska Medical University Pleven, Bulgaria
  • Snježana Tomić University Hospital of Split, University of Split - School of Medicine, Croatia
  • Eduard Vrdoljak University Hospital of Split, University of Split - School of Medicine, Croatia


Background. Recent evidence brought by novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates is leading to significant changes in HER2-negative breast cancer (BC) best practices. A new targetable category termed ‘HER2-low’ has been identified in tumors previously classified as ‘HER2-negative’. Daily practice in pathology and medical oncology is expected to align to current recommendations, but patient access to novel anticancer drugs across geographies might be impeded due to local challenges.

Materials and methods. An expert meeting involving ten regional pathology and oncology opinion leaders experienced in BC management in four Central and Eastern Europe (CEE) countries (Bulgaria, Croatia, Serbia, Slovenia) was held. Herein we summarize the current situation of HER2-low metastatic BC (mBC), local challenges, and action plans to prevent delays in patient access to testing and treatment based on expert opinion.

Results. Gaps and differences at multiple levels were identified across the four countries. These included variability in the local HER2-low epidemiology data, certification of pathology laboratories and quality control, and reimbursement conditions of testing and anticancer drugs for HER2-negative mBC. While clinical decisions are aligned to international guidelines in use, optimal access to testing and innovative treatment is restricted due to significant delays in reimbursement or limitative reimbursement conditions. 

Conclusions. Preventing delays in HER2-low mBC patient access to diagnosis and novel treatments is crucial to optimize outcomes. Multidisciplinary joint efforts and pro-active discussions between clinicians and decision makers are needed to improve care of HER2-low mBC patients in CEE countries.

Author Biography

Simona Borstnar




How to Cite

Borstnar, S., Božović -Spasojević, I., Cvetanović, A., Dedić Plavetić, N., Konsoulova, A., Matos, E., … Vrdoljak, E. (2024). Advancing HER2-low breast cancer management: enhancing diagnosis and treatment strategies. Radiology and Oncology, 58(2), 258–267. Retrieved from



Clinical oncology