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HER2-low scoring → T-DXd

Reading the faint end of the HER2 stain decides who gets Enhertu.

IHC 1+/2+ (low) and IHC 0 with faint staining (ultralow) predict T-DXd benefit in HR+ and TNBC. Reproducibility at the low end is poor; AI-assisted HER2 scoring is being validated.

Rationale
Bystander payload needs only minimal antigen for uptake; IHC cut-off is a delivery threshold not a driver threshold.
Evidence
Phase 3 (DESTINY-Breast04/06).

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