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Initial Tx asym. 60 yo, ER+/HER2+, liver, lung mets? Sym. pt?What initial first-line systemic therapy would you generally recommend for an asymptomatic 60-year-old patient with ER-positive, HER2-positive breast cancer and documented liver and lung metastases who has received no prior therapy? The same patient but symptomatic?Baselga J. Pertuzumab in combination with trastuzumab and chemotherapy for HER2-positive metastatic breast cancer (mBC) and clinical trials of the combination as adjuvant therapy for HER2-positive early-stage BC. Breast Cancer Update, Issue 2, 2013. Available at http://www.researchtopractice.com/browse-by-tumor-types/breast-cancer/5jcbe/12/2/jose%CC%81-baselga-md-phd/pertuzumab-combination-trastuzum. Baselga J et al. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 2012;366(2):109-19. Abstract Gradishar WL. Emerging approaches for treating HER2-positive metastatic breast cancer beyond trastuzumab. Ann Oncol 2013;24(10):2492-500. Abstract Miles D et al. Treatment of older patients with HER2-positive metastatic breast cancer with pertuzumab, trastuzumab, and docetaxel: Subgroup analyses from a randomized, double-blind, placebo-controlled phase III trial (CLEOPATRA). Breast Cancer Res Treat 2013;142(1):89-99. Abstract Mohammed A et al. Targeted therapy for breast cancer. Am J Pathol 2013;183(4):1096-112. Abstract Pritchard KI. Endocrine therapy: Is the first generation of targeted drugs the last? J Intern Med 2013;274(2):144-52. Abstract 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 |