In a patient with ER+/HER2+ breast cancer with significant residual disease post neoadjuvant TCHP, is there a role of using CDK4/6i in the adjuvant setting with T-DM1?

Would you add CDK4/6i to adjuvant T-DM1 in a patient with significant HR+/HER2+ residual disease after neoadjuvant TCHP?

• No, would use T-DM1 alone
• Yes, with abemaciclib for any patient who otherwise meets MonarchE criteria
• Yes, with ribociclib for any patient who otherwise meets NATALEE criteria
• Maybe, with abemaciclib - but only if extreme risk (eg >4 nodes + other risk factors such as tumor >5cm or high grade)
• Maybe, with ribociclib - but only if extreme risk (eg >4 nodes + other risk factors such as tumor >5cm or high grade)
• Other