When would you consider neratinib in a patient with locally advanced HR positive, Her2 positive breast cancer who received one year of trastuzumab and pertuzumab?  

There is no data on adjuvant neratinib following one year of trastuzumab and pertuzumab. However, as the added benefit of pertuzumab to herceptin in HR pos HER2 pos is minimum in the adjuvant setting, I would consider neratinib in high risk patients, for example being node positive.