What adjuvant therapy would you offer a post-menopausal CHEK2+ patient with HR+ HER2+ T1bN1 breast cancer and concurrent HR+ HER2- T1N0 disease?

These are hard cases. In general, the HER2 positive disease will take priority. Although it would be ideal to have treated the patient neoadjuvantly to assess response and potentially offer adjuvant TDM-1 per the KATHERINE trial, for now, I would optimize her therapy with adjuvant TCHP for 6 cycles ...