How do you manage adjuvant therapy for patients with locally advanced ER positive breast cancer with no response to neoadjuvant endocrine therapy?
For patients with ER+ locally advanced disease and no response to neoadjuvant chemotherapy (assuming an optimal chemo regimen was given -anthracycline and taxane based, my preferred regimen in this setting would be AC dose dense X4 with pegfligrastim followed by paclitaxel weekly X12) , then the tumor is unlikley chemosensitive and i would proceed with standard endocrine therapy (AI for postmenopasual woman for 5-10 years ; or Tamoxifen for premenopasual woman for 10 years). If the patient can have access to SWOG S1207 clinical trial "a phase III randomized , placebo-controlled clinical trial evaluating the use of Adjuvant endocrine therapy +/- one year of everolimus in patients with high risk, hormone receptor-positive and HER2 neu negativ...
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