Besides, the improvement of ADCs over lapatinib in HER2-positive metastatic breast cancer does not mitigate the superior efficacy of other target drugs like pyrotinib and neratinib.10,11 Previous real-world data also showed that pyrotinib achieved a longer survival than T-DM1 for patients with TKIs failure.12 Considering the cost-effectiveness, pyrotinib, instead of ADCs, is the level I recommendation for metastatic settings in Chinese Society of Clinical Oncology (CSCO) breast cancer guidelines even after approval of T-DM1 in 2021.13 This evidence concerns the gene ERBB2 and breast carcinoma.