How would you manage adjuvant therapy in a BRCA1-mutated woman with ER+, Her2 negative breast cancer with residual disease at surgery after neoadjuvant therapy with a taxane-based regimen?

There are several factors to consider in this case. One is whether the patient has received optimum chemotherapy. If there is only minimum residual disease at surgery, I would not recommend additional chemotherapy in the adjuvant setting. On the other hand, if there was significant residual disease at surgery and she had not received an anthracycline, I think it would be reasonable to complete the standard chemotherapy regimen. There is no data in supporting adjuvant platinum in ER+ breast cancer patients who had residual disease after standard neoadjuvant anthracycline and taxane based regimen. Participating in a clinical trial with platinum or a PARP inhibitor is appropriate. Additionally, non-pCR for ER positive breast cancer may not cor...