What adjuvant systemic therapy would you recommend for a woman s/p ALND for a nodal recurrence of ER-/HER2+ breast cancer 1 year after completing adjuvant therapy with paclitaxel/trastuzumab for her initial disease?  

If the axillary nodes were already dissected, I would try TCHP followed by HP since she is pertuzumab naive and she had a DFI of >12 months from paclitaxel. If she had her nodes clipped for neoadjuvant TCHP, I would have switched to adjuvant TDM1 if she had residual disease in the axillary nodes....

The nodal recurrence occurring about 1 year after Taxane/Trastuzumab adjuvant therapy would amount to inadequate initial systemic therapy and would suggest at-least a partial resistance to Taxane and Trastuzumab. For that reason, I would strongly consider incorporating Pertuzumab in combination with...

Based on the provided information, it sounds like this was initially a T1N0 hormone receptor negative HER-2-positive breast cancer, and after surgical treatment (not specified) treated with adjuvant weekly taxol and Herceptin. Provided limited information states that this was a nodal recurrence whic...

This is a great discussion thread. All the suggestions are reasonable considerations since there isn't data on the optimal treatment in this scenario. The main consideration for the TCHP was that the local recurrence occurred 21 months after the last weekly paclitaxel dose. Docetaxel+carbo x 6 cycle...