Would you use ado-trastuzumab as first line therapy for metastatic Her2+ breast cancer in a post-menopausal woman who developed metastatic disease years after finishing dual Her2 directed therapy?  

The FDA label provides for upfront useage of TDM1 if the patient develops metastatic recurrence within 6 months of adjuvant therapy. In this case since it has been years i would try dual blockade with TPH again as the patient may respond again.