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Over the past year, major advances\u2014including results from DESTINY-Breast05, DESTINY-Breast09, DESTINY-Breast11, PATINA, and long-term APHINITY follow-up\u2014have changed the treatment landscape regarding the place in therapy of antibody\u2013drug conjugates and the optimal sequencing of systemic therapies. These developments prompted the need for updated evidence-informed consensus recommendations to support consistent, high-quality care across Canada. Research Excellence, Active Leadership Canadian Breast Cancer Alliance (REAL Alliance), comprising clinical-academic oncologists from across Canada and Breast Cancer Canada, updated its 2024 HER2+ recommendations through a modified Delphi process with up to three rounds of anonymous voting. Consensus was defined a priori as \u226575% agreement. This 2025 update incorporates new data in early-stage, metastatic, and central nervous system-involved disease, including revisions to neoadjuvant and adjuvant treatment pathways and expanded guidance on the clinical use of antibody\u2013drug conjugates.<\/jats:p>","DOI":"10.3390\/curroncol33040200","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:23:17Z","timestamp":1774963397000},"page":"200","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for the Systemic Treatment of Patients with HER2+ Breast Cancer in Both the Early and Metastatic Settings (2025 Update)"],"prefix":"10.3390","volume":"33","author":[{"given":"Aalok","family":"Kumar","sequence":"first","affiliation":[{"name":"BC Cancer\u2014Surrey, University of British Columbia, Vancouver, BC V3V 1Z2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna J.","family":"Jerzak","sequence":"additional","affiliation":[{"name":"Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4111-2757","authenticated-orcid":false,"given":"Karen A.","family":"Gelmon","sequence":"additional","affiliation":[{"name":"BC Cancer\u2014Vancouver, University of British Columbia, Vancouver, BC V5Z 4E6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Fran\u00e7ois","family":"Boileau","sequence":"additional","affiliation":[{"name":"Jewish General Hospital, McGill University, Montr\u00e9al, QC H3T 1E2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathaniel","family":"Bouganim","sequence":"additional","affiliation":[{"name":"McGill University Health Centre, McGill University, Montr\u00e9al, QC H4A 3J1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4818-318X","authenticated-orcid":false,"given":"Christine","family":"Brezden-Masley","sequence":"additional","affiliation":[{"name":"Marvelle Koffler Breast Centre, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey Q.","family":"Cao","sequence":"additional","affiliation":[{"name":"Arthur J.E. 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