How would you manage a premenopausal female with cT2cN0 HR+/HER2-negative breast cancer who received neoadjuvant TC for high OncoType, had no pathologic response to therapy and upstaged to pT2N1 on surgery?

There is definitely a shift in administering more neoadjuvant therapy in ER+Her2- disease. However, I tend to avoid the use of TC in the neoadjuvant setting as the treating oncologist can be left with this conundrum. However, with the COVID pandemic and other reasons that may be needed to delay surgery, and the desire to avoid "overtreatment" with risk of cadiotoxicity and anthracycline, I think this can be a more common phenomenon to see TC in this space.

The lack of response and persistence of disease is a bit less concerning in the ER+Her2- space, where CR rates to chemotherapy are traditionally at or below 10%. However, I'm concerned about any evidence for response with this type of patient. The high oncotype score also tells you that th...

AI and ovarian suppression.

I will not give more chemotherapy.