How would you manage a patient with early stage ER+ HER2+ breast CA who cannot receive definitive local therapy due to severe cardiopulmonary co-morbidities?

My management would depend on the nature of the severe cardiopulmonary co-morbidity and the clinical stage of the disease. For someone who is not a candidate for surgery (even with local axillary block, etc.), but does not have a cardiomyopathy, and is otherwise fit for systemic therapy (ECOG PS 0-2...