In a patient with early stage HER2+ breast cancer s/p surgery, would you consider a noncytotoxic chemotherapy approach with anti-Her2 therapy alone if the PS is borderline and/or patient declines chemotherapy?

We now have evidence from several prospective clinical trials enrolling elderly patients and patients who were not fit to receive chemotherapy demonstrating that single agent adjuvant trastuzumab treatment is active and offers a reasonable treatment option without any significant risk of cardiac toxicity even if avoidance of chemotherapy results in a very modest reduction of survival benefit. I would consider offering this patient adjuvant therapy with trastuzumab for 1 year.