What is your treatment approach in a patient with cT2 ER+HER2+ breast cancer who refuses neoadjuvant chemotherapy?

Standard neo-adjuvant chemotherapy that contains trastuzumab, pertuzumab carboplatin, and docetaxel is recommended for most cases of HER2+ breast cancer (although other, anthracycline-containing regimens also exist but are used increasingly less commonly). If this patient refuses neo-adjuvant chemotherapy, the same regimen can be recommended in adjuvant setting but the prognostic and predictive value of pathologic response to neo-adjuvant chemotherapy will be lost which could impact the patient'...

First, I would take the time to explain to the patient why neoadjuvant treatment is so important. Second, I would try to determine if it is cytotoxic chemotherapy she is not willing to take or both cytotoxic and intravenous/oral HER2 targeted targeted therapy. Third, I would ask if the patient is willing to receive adjuvant therapy while she is refusing neoadjuvant therapy.

If she is willing to receive adjuvant cytotoxic chemotherapy and be able to tolerate, TCH (docetaxel/carboplatin/trastuzumab...