Where does the OPTIMA trial, presented at ASCO 2026, fit into decision-making for chemotherapy for premenopausal women with high clinical and low genomic risk ER+ breast cancer?

Since the median follow-up on this trial was only 4 years (which is considered short for patients with operable, hormone receptor-positive, HER2-negative breast cancer) and since the study has not yet been published in a peer-reviewed journal, I would exercise extreme caution in skipping potentially...

For premenopausal patients with pN2/pN3, the current guideline recommendation is adjuvant chemotherapy followed by endocrine therapy ± ovarian suppression/ablation (category 1), with no genomic assay step in the decision pathway. No genomic assay is validated yet.

The OPTIMA trial presented at ASCO ...