Would you modify your initial treatment for a patient with de novo metastatic HR- HER2+ breast CA who has cardiomyopathy at baseline (EF < 35)?  

Fortunately, the incidence of cardiotoxicity with the combination of a taxane, trastuzumab, and pertuzumab is very low, and thus I would be comfortable starting with this treatment (preferably with weekly paclitaxel) and monitoring her with periodic echocardiograms (every 4-6 cycles, in the absence ...