What adjuvant systemic therapy would you offer to a healthy elderly woman with a 5mm, node negative, grade 2 HR+HER2+ invasive lobular carcinoma?

Although several studies have clearly indicated a higher risk of recurrence for early stage HER2+ breast cancers, the absolute risk for T1aN0 breast cancers is still quite low. The studies have been limited by small numbers, but there are retrospective series suggesting excellent outcomes without ad...

I would discuss weekly paclitaxel/trastuzumab followed by AI vs trastuzumab x 12 mos plus AI. The Japanese RESPECT trial randomized 275 women aged 70-80 with mostly stage I (>5mm)-II HER2+ tumors to adjuvant chemo+trastuzumab vs trastuzumab alone. The events were too few to do the planned analysis b...

Based on advanced age and a very small tumor, I would use endocrine therapy alone, using an AI like Letrozole.

AI only.