How do you use neratinib in HR+ HER2+ patients in the adjuvant setting if patients got adjuvant T-DM1 for residual disease after neoadjuvant therapy?

I do not routinely apply neratinib. I base the decision on my best estimate of two factors:

1. The obvious issues with neratinib toxicity
2. The residual risk that the patient has after TDM1. Not all residual disease patients are equal. I would approach a patient with a minimal response to neoadjuvant th...