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Initial Tx asym. 60 yo, ER+/HER2+, bone mets? Sym. pt?What initial first-line systemic therapy, other than bone-directed treatment, would you generally recommend for an asymptomatic 60-year-old patient with ER-positive, HER2-positive breast cancer and several documented bone metastases who has received no prior therapy? The same patient but symptomatic?Baselga J et al. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 2012;366(2):109-19. Abstract Blackwell KL. Overall survival benefit with lapatinib in combination with trastuzumab for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer: Final results from the EGF104900 Study. J Clin Oncol 2012;30(21):2585-92. Abstract Doss S et al. Lapatinib or trastuzumab in combination with an aromatase inhibitor for first-line treatment of metastatic hormone-receptor-positive breast cancer that overexpresses HER2. Lancet Oncol 2012;13(8):766-7. Abstract MARIANNE: A study of trastuzumab-DM1 plus pertuzumab versus trastuzumab [Herceptin] plus a taxane in patients with metastatic breast cancer. NCT01120184 Swain SM et al. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA study): Overall survival results from a randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol 2013;14(6):461-71. Abstract Verma S et al. Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med 2012;367(19):1783-91. Abstract Wilson S, Chia SK. Treatment algorithms for hormone receptor-positive advanced breast cancer. Am Soc Clin Oncol Educ Book 2013:20-7. Abstract |