However, most are not studied in the renal replacement therapy (RRT) setting.<h4>Case report</h4>We report the use of Phesgo® (subcutaneous fixed-dose combination of trastuzumab and pertuzumab) combined with exemestane as a first-line treatment of metastatic HER2-positive breast cancer in a hemodialysis patient with multiple comorbidities. The gene discussed is ERBB2; the disease is breast carcinoma.