What adjuvant therapy would you offer an elderly but healthy patient with T2N1 HR+ HER2+ breast cancer who is not willing to receive cytotoxic chemotherapy?  

The Japanese RESPECT trial (Sawaki et al., PMID 32936713) compared trastuzumab alone (T) vs chemo+trastuzumab (Ch+T) in patients >=70 and demonstrated a 3 year DFS of 89.5% (T) vs 93.8% (Ch+T) HR 1.31 p=.51. Based on this data, you could discuss adjuvant AI+trastuzumab for 1 year.