T-DM1+Pertuzumab in Pre-OP Early-Stage HER2+ BRCA

Inclusion Criteria: * Patients must have HER2-positive Stage II or III histologically confirmed invasive carcinoma of the breast. A minimum tumor size of 2 cm determined by physical exam or imaging is required. * HER-2 positive, confirmed by central testing (Clarient labs): IHC 3+ and/or FISH positive based on one of the three following criteria: * Single-probe average HER2 copy number≥6.0 signals/cell OR * Dual-probe HER2/CEP17 \<2.0 with an average HER2 copy number ≥6.0 signals/cell OR * Dual-probe HER2/CEP17 ratio ≥2.0 * ER/PR determination is required. * Bilateral breast cancers are allowed if both cancers are HER2-positive. * Patients with multifocal or multicentric disease are eligible as long as one area meets eligibility criteria. * Breast imaging should include the ipsilateral axilla. For subjects with a clinically negative axilla, a sentinel lymph node biopsy will be performed either before or after preoperative therapy at the discretion of the subject's physicians. For subjects with a clinically positive axilla, a needle aspiration, core biopsy or SLN procedure will be performed to determine the presence of metastatic disease in the lymph nodes. * Men and women (with any menopausal status) ≥ 18 years of age * ECOG performance status 0 or 1 * Required laboratory values: * ANC ≥1500/mm3 * Hemoglobin ≥ 9 g/dl * Platelets ≥100,000/mm3 * Serum creatinine \< 1.5 X ULN (institutional) * Total bilirubin ≤ 1.0 X ULN (institutional) For patients with Gilbert synd…