How would you approach adjuvant systemic therapy in a HR+ premenopausal patient over the age of 50?

Since you are citing the RxPONDER study, I assume this is a premenopausal woman over age 50 with N1 node positive disease.

In the RxPONDER study, for premenopausal women, the 5-year HR for iDFS with chemo was 0.6. Same for distant DFS. But the benefit was mainly seen in premenopausal women under 50. ...

This question gets to the heart of a conundrum. I will give some thoughts, but I know there are lots of opinions and I am curious what others think.

The average age of menopause in the United States is 49.9 years old (Appiah et al., PMID 33821908). As a caveat, I do personally believe that breast can...