The ATEMPT trial showed adjuvant TDM1 was associated with lower rates of significant neuropathy vs TH (11% vs 23%). Also, CMF (4-6 cycles) plus trastuzumab-based off of Tryfonidis et al., PMID 28324265 safety data is another option for early-stage HER2+ breast cancer in patients with significant pre...

I would consider adjuvant T-DM1 based on data from ATEMPT suggesting a 3 yr DFS of ~98%, with significantly less neuropathy than TH for this patient population.

I agree that CMF-trastuzumab is a reasonable alternative to avoid further neurotoxicity. It is important to note that the adjuvant CMF-trastuzumab reported in the EORTC 10995 was the classic Bonadonna regimen (cyclophosphamide 100 mg/m2 orally days 1–14; methotrexate 40 mg/m2 IV days 1 and 8; ...

I think we have to be careful not to cause severe and possibly permanent toxicity, such as progressive neuropathy, for a small benefit. I think ATEMPT is an excellent study (except, perhaps, for the duration of the T-DM1), and often wish I could get insurance approval (which I find to be a problem) ...

I think we need to be a bit careful about interpreting the ATEMPT data and assuming TDM-1 is a better regimen for older patients or those with pre-existing comorbidities. In terms of quality of life, the patients randomized to TDM-1 had a higher quality of life at baseline, which was maintained. In ...