What adjuvant therapy would you offer a postmenopausal woman with a new pT2N0 HR+/HER2+ breast cancer primary who is concurrently being treated with anastrozole/ribociclib for well controlled oligometastatic HR+/HER2- disease?

It is always disconcerting when a primary tumor arises in the context of already ongoing therapy. Presumably, this tumor is somewhat resistant. Firstly, I would add in anti-HER2 therapy (there is a broad range of options depending on the patient's details, ranging from single-agent trastuzumab to TH...