What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?

She would be given the options of tamoxifen or ovarian suppression with an AI for five years and then a discussion at that time based on where the data goes in that time. Tamoxifen would have fewer side effects but less effective reduction of PFS per extrapolation from the SOFT/TEXT trials. Ovarian suppression with an AI would provide the greatest reduction in recurrence risk, but would carry increased risk of osteoporosis and slightly more menopausal side effects. Though she has a somewhat bett...

In these higher risk patients, I extrapolate from SOFT/TEXT and offer OS/AI.

The patient is at high risk. I would recommend ovarian suppression (SOFT and TEXT approach) along with anti-Her2 therapy.