Patients that are Her2 / Neu-positive disease and a positive lymph node will need systemic chemotherapy in combination with Her2 / Neu-directed immunotherapy.
Neoadjuvant treatment is preferred, as this can downstage the disease, making her a candidate for lumpectomy and targeted axillary node dissection rather than conventional axillary node dissection.
The patient will need systemic chemotherapy in the form of docetaxel /carboplatin or adriamycin / cyclophosphamide in addition to Her2-directed therapies.
21-gene assay is used to predict benefit from systemic chemotherapy in women who have hormone receptor positive, Her2/neu-negative breast cancer.
National Comprehensive Cancer Network (NCCN) Guidelines 2017 – Breast Cancer
Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, Lebeau A, Liedtke C, von Minckwitz G, Nekljudova V, Schmatloch S, Schrenk P, Staebler A, Untch M. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013 Jun;14(7):609-18.