Does ER+ status impact your choice of neoadjuvant systemic therapy in premenopausal women with cT2N0 HER2+ breast cancer?
In general for T2N0 HER2+ breast cancer, I would recommend neoadjuvant TCH or AC-TH, or one of those regimens + pertuzumab, with the decision about inclusion vs omission of pertuzumab based on the limited absolute benefit in APHINITY for node negative breast cancer; but understanding that with a neo...
In the neoadjuvant setting, the goal is to try to achieve pCR, which will help you decide whether to administer T-DM1 in the adjuvant setting and to minimize toxicity without sacrificing efficacy. While there has not been (and is not likely to be) a large study demonstrating higher pCR rates (or imp...
PCR rates will likely be lower with neoadjuvant HER2 directed therapy; however there is little data to modify approach based on ER positivity. Of course, there is now the option to use TDM1 for residual disease post neoadjuvant treatment.
Neratinib can be considered in this subset after completion ...