Should neoadjuvant chemotherapy be recommended for HER2+, clinically LN- breast cancer measuring 2-3cm?

For cT2N0 2-3 cm HER2+ tumors I am still doing neoadjuvant dual blockade chemotherapy for eligible patients in order to assess their pCR status. This guides adjuvant therapy per the KATHERINE study. I usually reserve the APT approach for cT1N0 patients who go to surgery first and are still a stage 1...

Given excellent results and follow up of APT trial, I prefer paclitaxel and trastuzumab in tumors up to 3 cm. I do not want to give pertuzumab and expose patient to toxicity.