How do you utilize CDK 4/6 inhibitors in metastatic ER+ HER2+ breast cancer?  

One such patient progressed through trastuzumab/pertuzumab/letrozole and TDM1 alone.  How would you combine ER+ approaches (eg CDK 4/6 inhibitor + AI) with HER2+ therapy (eg trastuzumab) for the next line of treatment?



Answer from: Medical Oncologist at Academic Institution