Algeria The management of HER2-positive breast cancer has changed substantially over the past decade. In Algeria, the 2026 therapeutic guidelines now reflect an increasingly response-adapted approach, particularly after neoadjuvant treatment.
For patients with HER2-positive early breast cancer who are candidates for neoadjuvant therapy, treatment may include chemotherapy combined with trastuzumab and pertuzumab. But increasingly, an important question comes after surgery:
Did the tumour completely respond?Pathological response now guides the next step
Surgery no longer necessarily marks the end of systemic treatment planning.
According to the 2026 Algerian therapeutic framework, patients who achieve a pathological complete response (pCR) after neoadjuvant treatment continue anti-HER2 therapy to complete approximately one year of treatment.
For patients with residual invasive disease, the strategy changes: adjuvant T-DM1 is recommended rather than simply continuing trastuzumab.
This is an important practical evolution. The surgical specimen is not only providing prognostic information—it can directly influence the patient’s subsequent systemic treatment.
Why this matters in Algeria
For an Algerian oncology team, this approach makes coordination between the breast surgeon, pathologist and medical oncologist particularly important.
The pathology report following neoadjuvant therapy needs to clearly establish whether invasive residual disease is present. That result can determine whether the patient continues standard anti-HER2 therapy or moves to an antibody–drug conjugate.
The RCP therefore becomes an important point of transition:
neoadjuvant treatment → surgery → pathological assessment → treatment adaptation.
This also highlights the importance of access. A treatment strategy can only be implemented if the relevant pathology is available and the recommended systemic therapies can actually be delivered.
Beyond trastuzumab
The evolution of HER2-positive breast cancer is increasingly moving toward response-adapted therapy rather than one treatment pathway for every patient.
For Algerian practice, this means that the question is no longer simply:
“Is this HER2-positive?”
It is increasingly:
“How did this HER2-positive tumour respond to neoadjuvant therapy, and what treatment should follow?”
The 2026 Algerian guidelines place this response-based approach within the national treatment framework.
For patients with HER2-positive breast cancer, the post-operative pathology report has become a treatment decision point—not simply the final chapter of surgery.
