65 yr old female who just completed neoadjuvant Taxol/Herceptin/Perjeta for 1.9cm T1cN0 Her2+/ER+ IDC. Lumpectomy and SLNB: 1.4 mm residual disease, ypT1aN0. Would you offer Kadcyla? ECOG 0. Or what benefit should I explain for her to choose between that an Herceptin/AI.

Breast Cancer Specialist

This is tough. The Katherine trial showed a benefit regardless of extent of residual disease so I would if you think she would tolerate it. Having said that she wouldn’t have met the criteria for Katherine because she would have needed more chemo neoadjuvantly. But I’d give it.