What treatment options would you provide a HER2+/HR+ patient with significant residual disease s/p TCHP if they go on to develop severe neuropathy following adjuvant T-DM1 therapy?

We know from the KATHERINE study that invasive disease or death had occurred in 12.6% of the T-DM1 group and in 22.2% of the trastuzumab group. The estimated percentage of patients who were free of invasive disease at 3 years was 88.3% in the T-DM1 group and 77.0% in the trastuzumab group. However, for patients who are intolerant of TDM-1, the only choice we have is to go back to adjuvant trastuzumab and pertuzumab combination. Pertuzumab may add around 2% absolute benefit to trastuzumab, so I would say we can reduce the 22.2% iDFS rate to around 20%. In addition, for ER+HER2+ disease, you can also consider adding neratinib after completion of adjuvant trastuzumab and pertuzumab. There is currently no data for the use of neratinib after adj...