For a patient with isolated CNS recurrence of HR+HER2+ breast cancer after completion of adjuvant therapy, what, if any, systemic therapy would you start after completion of local therapy?  

Of note, the patient received cytotoxic plus HER2 directed adjuvant therapy but declined endocrine therapy. 

Answer from: Medical Oncologist at Community Practice

Answer from: Medical Oncologist at Academic Institution
Medical Oncologist at NYU Winthrop Hospital
2nd line Tucatinib HER2CLIMB study
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