60 yo, 2.1-cm node-neg IDC, ER-neg/HER2+, adj AC 
TH: Tx if lumpectomy bed recurrence 2 y later and NED?
A 60-year-old woman, s/p lumpectomy for a 2.1-cm IDC, negative nodes: The patient receives AC TH, but 2 years later a small lesion is removed from the breast in the lumpectomy bed that proves to be a recurrence. No other disease is detected clinically or on imaging. The primary tumor and the recurrence appear similar histologically and are ER-negative, HER2-positive. What systemic treatment would you recommend?
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