Approximately 20% of invasive breast cancers have upregulation/gene amplification of the oncogene human epidermal growth factor receptor-2 (HER2/ErbB2). Of these, some also express steroid receptors (the so-called Luminal B subtype), whereas others do not (the HER2 subtype). HER2 abnormal breast cancers are associated with a worse prognosis, chemotherapy resistance, and sensitivity to selected anti-HER2 targeted therapeutics. Transcriptional data from over 3000 invasive breast cancers suggest that this approach is overly simplistic; rather, the upregulation of HER2 expression resulting from gene amplification is a driver event that causes major transcriptional changes involving numerous genes and pathways in breast cancer cells. Most notably, this includes a shift from estrogenic dependence to regulatory controls driven by other nuclear receptors, particularly the androgen receptor. We discuss members of the HER receptor tyrosine kinase family, heterodimer formation, and downstream signaling, with a focus on HER2 associated pathology in breast carcinogenesis. The development and application of anti-HER2 drugs, including selected clinical trials, are discussed. In light of the many excellent reviews in the clinical literature, our emphasis is on recently developed and successful strategies to overcome targeted therapy resistance. These include combining anti-HER2 agents with programmed cell death-1 ligand or cyclin-dependent kinase 4/6 inhibitors, targeting crosstalk between HER2 and other nuclear receptors, lipid/cholesterol synthesis to inhibit receptor tyrosine kinase activation, and metformin, a broadly inhibitory drug. We seek to facilitate a better understanding of new approaches to overcome anti-HER2 drug resistance and encourage exploration of two other therapeutic interventions that may be clinically useful for HER+ invasive breast cancer patients.A robust and reliable determination of hormone receptor and HER2 "status" in newly diagnosed breast cancer is more difficult to achieve than it may seem. Some of this is due to clinical and surgical nuances of individual patient tumors, as well as the distance and time required for transportation of the biopsy, examination, and processing by pathology. Clinical teams should adhere to the most recent widely accepted practice guidelines, developed by a working group and codified by the College of American Pathologists and the American Society of Clinical Oncology (www.asco.org/breast-cancer-guidelines) [13] . These recommendations include the use of FDA approved reagents, test, and reporting methodology. Testing must be performed in a clinical laboratory improvement amendments-certified laboratory, using appropriate controls and validated assays. Each of these assays requires a pathologist to perform a semi-quantitative analysis of the cancer sample using evidence-based interpretive guidelines and visual microscopy [14] .