How do you treat patients with early-stage ER+/Her2- breast cancer who recur years later after definitive therapy and hormonal therapy?

There's a lot of nuances to this question. What's the disease burden? Is there considerable visceral disease? What is the performance status of the patient? And finally, patient preference? If there is considerable visceral disease, I do consider single agent chemotherapy for a few cycles, and very rarely doublet regimen.

In situations where I think cytotoxic chemotherapy is not indicated, I try to understand the tumor biology. Did the patient recur while being on an AI or tamoxifen? In such an instance, I will consider adding palbociclib to the AI, or using the combination of palbociclib with fulvestrant (approved in second-line or beyond). The combination works well regardless of presence or absence of ESR1 mutations (ASCO 2016).