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A major change has taken place in the treatment of human epidermal growth factor receptor 2 (HER2) positive breast cancer in recent decades, largely as a result of the development of targeted anti-HER2 treatment. This type of breast cancer accounts for approximately 13 % of all breast cancer cases diagnosed annually. Treatment options have evolved from a single HER2-targeted monoclonal antibody (trastuzumab) to a range of targeted and potent drugs. Collectively, these advances have led to significant improvements in prognosis and survival for patients with HER2-positive breast cancer. This clinical review outlines the development of HER2-targeted therapies and key principles of current treatment for both localised and metastatic disease.