Would you offer trastuzumab + pertuzumab alone for patients with early stage, HER2+ breast cancer for whom TCHP is clearly indicated but who adamantly refuse any cytotoxic therapy?

Yes, I would use this regimen pre-operatively, since our general process is to use TCHP (or THP) and de-escalate as needed for toxicity for patients with clinical stage T2 or N1 or higher. Here, the "de-escalation" is immediate due to strong patient preference (which of course should be documented)....

I agree with the answers above. I have recommended TDM-1+P as per KRISTINE in similar situations if pt is open to it. pCR rates of 44%

Hurvitz et al., Lancet Oncol 2018

Based on the ATEMPT trial presented at SABCS 2019, one could consider using TDM-1 alone as adjuvant treatment if you could get insurance coverage. I would think this would be more reasonable for an early stage cancer than HP alone, which we know has an inferior response than combined with a cytotoxi...