ERBB2 and neoplasm: It is well known that de novo metastatic HER2+ patients with breast cancer have better outcomes than women with metastatic relapse.9 This could be related both to a lead time bias, as well as to an ATRESS (adjuvant therapy-related shortening of survival) phenomenon.10 Indeed, cancer treatments may induce clonal selection, as well as tumor resistance and aggressiveness, which could explain a reduced progression-free survival (PFS) at relapse and a significant impact on overall survival (OS).9,11