Patient description: The patient is a 45-year-old postmenopausal woman with cytologically confirmed breast cancer. A core biopsy revealed a 3 cm invasive ductal breast carcinoma in the left upper outer quadrant. The tumor is HER2-positive and ER/PR negative. Axillary sampling revealed 5 positive lymph nodes. CXR was remarkable for metastatic lesions. The patient is using multivitamins and iron supplements. She does not smoke or consume alcohol. She is not sexually active and has no children. She is a candidate for tumor resection and agrees to do so prior to chemotherapy.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Breast Cancer Stage II Breast Cancer Stage III Breast Cancer HER2-positive Breast Cancer Stage II or III (according to AJCC cancer staging manual anatomic staging table, 8th edition) histologically confirmed invasive carcinoma of the breast. A minimum tumor size of 1.5 cm (in breast mass or axillary lymph node) determined by physical exam or imaging (whichever is larger) is required. Patients with inflammatory breast carcinoma (T4d) are NOT eligible Centrally confirmed to have a low affinity CD16 germline genotype (FF or FV) HER-2 positive by 2018 American Society of Clinical Oncology/College of American Pathologists as assessed by standard institutional guidelines (central testing is not required) ER/PR determination is required. ER and PR-assays should be performed by immunohistochemical methods according to standard institutional guidelines Bilateral breast cancers are allowed as long as both cancers are HER2-positive (as defined in 3.1.2), or the contralateral cancer is a <1 cm, ER+ tumor Patients with multifocal or multicentric disease are eligible if the treating investigator has determined the patient should be treated as HER2-positive Breast imaging should dedicated ultrasound of the ipsilateral axilla. For subjects with a clinically positive axilla based on exam or imaging, a fine needle aspiration or core biopsy procedure will be performed to determine the presence of metastatic disease in the lymph nodes (though lymph node sampling procedure need not be resulted prior to patient's registration on trial, as long as all other are met) Men and women (with any menopausal status) ≥18 years of age are eligible ECOG performance status 0 or 1  Pregnant or nursing women due to the teratogenic potential of the study drugs Active, unresolved infection requiring intervention Receipt of intravenous antibiotics for infection within 7 days prior to registration Uncontrolled hypertension (systolic >180 mm Hg and/or diastolic >100 mm Hg) or clinically significant (i.e. active) cardiovascular disease: cerebrovascular accident/stroke or myocardial infarction within 6 months prior to first study medication, unstable angina, congestive heart failure (CHF) of New York Heart Association (NYHA) Class II or higher, or serious cardiac arrhythmia requiring medication Significant symptoms (Grade ≥ 2) from peripheral neuropathy Other concurrent serious diseases that may interfere with planned treatment, including severe pulmonary conditions/illness, uncontrolled infections, uncontrolled diabetes Any prior treatment for the current breast cancer, including chemotherapy, hormonal therapy, radiation, or experimental therapy Patients with any prior history of invasive breast cancer within the past 5 years are not eligible. Non-metastatic invasive breast cancers diagnosed more than 5 years ago and any other type of prior non-metastatic cancer is allowed