
Demographics:
* Age: 57
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210

57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.
Your reply should be structured in the following format:

Case summary: Summarize the salient features of the case

Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used.

Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for?

Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen.

Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family?

Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways.

Case text: 
Demographics:
* Age: 57
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210

57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.
For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 
Demographics:
* Age: 57
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210

57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.
For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 
Demographics:
* Age: 57
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210

57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.
After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 
Demographics:
* Age: 57
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210

57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.
Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 
Demographics:
* Age: 57
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210

57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.
What psychosocial support and counseling would you recommend for this patient? Case: 
Demographics:
* Age: 57
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210

57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.