A cohort study of the National Cancer Database involving approximately 7000 T1–2/N0 HER2+ patients revealed that those without pCR after neoadjuvant chemotherapy had poor outcomes.33 This finding highlights that the neoadjuvant approach might be important to identify nonresponders, who could potentially benefit from intensified treatment.33 At present, there is no mechanism by which to stratify T1N0 tumors that aids in identification of those best suited to receive neoadjuvant therapy as a means to optimize adjuvant therapy. This evidence concerns the gene ERBB2 and cancer.