For ER+ breast cancers that are clinical Stage IIB (T2N1) nearing locally advanced stages, what criteria do you use to determine if you would offer neoadjuvant chemotherapy?

This is an interesting question. Assuming this is regarding ER positive but HER2 negative tumors, the factors I would consider that would favor the decision to use upfront chemotherapy are the following:

1. Tumors that are grade 3 or high Ki-67

2. Low ER positive tumors

3. Younger, premenopausal wom...

I agree with the eloquent answer from @Dr. First Last.

I do exercise caution in doing Neo-adjuvant chemotherapy for ER positive, Her 2 Negative ( Luminal A) cancer outside of T3/4 or N2/3 disease.

Need for chemotherapy in ER positive T2N1 disease can't be ascertained without genomic assays.

We do have...

if Her-2 NEU positive would definitely do neoadjuvant therapy , as if residual disease at end of neoadjuvant would be eligible for futher anti her-2 neu therapy