ERBB2 and metastatic neoplasm: Combination of chemotherapy with dual HER2 targeting with trastuzumab and pertuzumab are the prevailing therapeutic approaches for HER2+ tumors in the neoadjuvant setting and in the first-line treatment of metastatic disease; trastuzumab and lapatinib (a dual EGFR/HER2 tyrosine kinase inhibitor small molecule) can also be used in refractory patients with advanced disease (4, 5); T-DM1 has been approved for treating advanced HER2+ breast cancer patients with progressive disease following trastuzumab/pertuzumab and chemotherapy regimens (6).