How would you approach a locally recurrent HER2 positive breast cancer patient previously treated with TCHP, lumpectomy, and a year of adjuvant TDM-1?  

Patient was initially ER positive, HER2 positive. Currently she is on letrozole. Recurrence is ER/PR negative and HER2 positive and developed almost 2 years after completing adjuvant therapy.

Answer from: Medical Oncologist at Academic Institution