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 ...

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.