Breast cancer
UPDATED --- Systemic therapy for HER2-positive early breast cancer

Patricia (68 years old)

Patricia is the 68-year-old retired gardener of a fairy tale castle. She loves roses and grows 60 different kinds in her huge garden. Five months ago, HER2-positive breast cancer was diagnosed.

Assessment summary

  • Postmenopausal
  • No relevant medical history
  • ECOG PS: 0
  • Initial tumour assessment:
    • Tumour stage: cT2 (32 mm), cN0, cM0
    • Tumour biology: ER 90%, PgR 80%, HER2 IHC 3+, G2
  • Neoadjuvant chemotherapy and anti-HER2 therapy refused by patient (insisted on primary surgical therapy)
  • Surgical therapy: breast conserving surgery + SLNB
    • Tumour stage: pT2 (35 mm), pN0 (0/3 sn)
  • Adjuvant chemotherapy: anthracycline/taxane-based chemotherapy + trastuzumab every 3 weeks
  • Today: 4 cycles anthracycline and 12 cycles paclitaxel received 
    • Mild polyneuropathy, no other relevant side effects
    • Radiation therapy will start, the patient asks how the systemic therapy will continue

Which option would you choose for this patient?