How do you approach a BRCA-mutated, premenopausal woman with metastatic ER+, Her2+ carcinoma with progression on THP?

This is probably not a common scenario, but one that theoretically crosses 3 areas of metastatic disease with largely non overlapping clinical trial data. It is somewhat unusual because premenopausal women with ER-positive/HER2 positive breast cancer have disease that is typically sensitive to estro...

The case describes a fair amount of visceral disease and progression relatilvely early in the course of THP (4months), so I would lean towards either another chemotherapy with trastuzumab or T-DM1. The EMILIA study demonstrated improved outcomes compared to capecitabine and lapatinb and although thi...