For the 45-year-old patient with a 0.8-cm tumor, I would recommend TCH. If fertility is an issue, I would feel comfortable with 12 weeks of paclitaxel/trastuzumab. I don’t believe that the benefit with chemotherapy is great, but I have to administer it to obtain the benefit of trastuzumab. I don’t want to choose a regimen that will cause long-term toxicity, so I usually treat with TCH and avoid an anthracycline-containing regimen. I usually administer anthracyclines if persistent disease remains after treatment with 6 cycles of TCH in the neoadjuvant setting.

I would generally administer TCH to a 70-year-old woman with ER-negative, HER2-positive early breast cancer and 1 positive node.

I would recommend the Stephen Jones regimen of TC with trastuzumab for a 45-year-old patient with a 0.8-cm tumor. The data regarding treatment of T1a/bN0, HER2-positive tumors are not clear. The original detection of HER2 was an oncogene with poor prognostic features. So for a young, healthy patient, I tend to be moderately aggressive. Also, I would have enrolled this patient on the Dana-Farber Phase II trial of paclitaxel/trastuzumab that was open a couple of years ago. The results of that study should be reported at the next San Antonio meeting.

For the 70-year-old woman, I would generally administer TCH. I usually recommend AC TH for patients who are young or those with high-risk disease. I would administer TCH to patients with lower-risk disease or those with comorbidities and high-risk disease.

Answer: Pac + trastuzumab; AC TH or TCH or taxane + trastuzumab

For a 45-year-old patient with a 0.8-cm, node-negative, HER2-positive early breast cancer, I would consider paclitaxel/trastuzumab. I would also discuss aggressive treatment with the patient, and if we opted for that, AC TH would be my preference. Depending on the outcome of my discussion with her, my treatment choice may be taxane/trastuzumab, especially because she would have been eligible for the Dana-Farber Phase II trial of paclitaxel/trastuzumab.

For the 70-year-old woman, I would generally recommend AC TH unless she has cardiac risk factors or a low ejection fraction. In that case, I would consider TCH. I would also consider a taxane with trastuzumab because, from the results of the metastatic trials, I am not convinced that carboplatin necessarily adds benefit to docetaxel.

I believe TCH is a toxic regimen for a 70-year-old. So even though we have fewer data to back it up, I may also consider a regimen that I believe is appropriate for this patient. I might administer the Dana-Farber regimen of weekly paclitaxel for 12 weeks with a year of trastuzumab, because she would have met the eligibility criteria for the Phase II study and I know, although it’s not been officially reported, that patients have experienced extremely low relapse rates on that study to date.

Answer: Pac + trastuzumab; dd AC TH

For this 45-year-old patient with a 0.8-cm tumor, I would recommend treatment with paclitaxel for 12 weeks and trastuzumab. We don’t have good data to support any particular regimen for patients who are either not eligible or barely eligible for randomized trials. We have enrolled patients with low-risk disease in the Dana-Farber Phase II trial of paclitaxel and trastuzumab. The results of the study should be reported soon, and we’re optimistic that this will be a good option for these patients.

For the 70-year-old woman, I would generally administer dose-dense AC TH. I tend to recommend dose-dense AC TH for patients at high risk who would have qualified for a randomized trial such as the BCIRG 006 study.

Answer: Pac + trastuzumab; AC TH or TCH or taxane + trastuzumab

I would administer paclitaxel and trastuzumab for a 45-year-old patient if the tumor were 0.8 centimeters in size. We have no clear data for patients with low-risk disease. Our center is exploring the use of paclitaxel and trastuzumab, which may hold promise for these patients.

The case of a 70-year-old woman with ER-negative, HER2-positive early breast cancer and 1 positive node is a difficult one for which we have no good answer. However, I would most likely administer AC TH. As an alternative, I may consider recommending TCH or a taxane with trastuzumab for this patient.

I would recommend treatment with paclitaxel for 12 weeks along with trastuzumab for a patient with a 0.8-cm tumor. Studies comparing trastuzumab-containing regimens to those without trastuzumab show a consistent benefit with trastuzumab-based therapy. The BCIRG 006 study suggested that AC TH was a slightly superior regimen but also carried a higher risk of cardiac toxicity. For patients with smaller, node-negative disease who have a lower risk of recurrence, I would prefer to minimize potential toxicity.

I would recommend TCH for the 70-year-old woman with ER-negative, HER2-positive early breast cancer and 1 positive node.

I would opt for 4 cycles of TCH using the Slamon regimen for the 45-year-old patient with a 0.8-cm tumor. I consider factors such as the patient’s age, cardiac risk factors and risk of recurrence when making my treatment decisions. I use 4 cycles of therapy because a study by Stephen Jones using 4 cycles of the docetaxel/cyclophosphamide/trastuzumab regimen for women with early-stage breast cancer demonstrated that this was effective in the adjuvant setting. I use the Slamon TCH regimen with carboplatin because it’s FDA approved and I am comfortable administering 4 cycles to patients with T1a/T1b breast cancer. If the patient has small node-negative disease, the incremental difference between TCH and AC TH is probably nil. As you move to higher-risk disease, the 3% absolute difference between AC TH and TCH might become more meaningful.

For a 70-year-old woman with 1 positive node, without hypertension and with an LVEF higher than 55%, I might lean toward TCH, all other things being equal.

I would opt for weekly paclitaxel for 12 weeks with a year of trastuzumab for a 45-year-old patient with a 0.8-cm tumor. I consider factors such as the patient’s age, size of the tumor, ER status and nodal involvement in making my decision. For a young patient with high-risk disease I tend to favor an anthracycline-based regimen, and I use a nonanthracycline-based regimen for patients with low-risk disease.

For the 70-year-old woman, I am more likely to recommend treatment with TCH to limit cardiac toxicity.