How would you treat isolated axillary recurrence of a previously node negative ER/PR+, HER2- breast cancer after prior neoadjuvant chemotherapy, lumpectomy/adjuvant RT, and adjuvant AI?

The problem of isolated local or regional recurrence has been a vexing one for years. There have been multiple attempts to complete a randomized trial with sufficient numbers to draw conclusions and none have succeeded. I was Principal Investigator for one such Intergroup trial in the 1980's closed for lack of accrual.The CALOR trial completed such a study but numbers were small (<200). They concluded that chemo was beneficial; however, in an underpowered subset analysis only the ER neg. pts. benefitted.

MDACC has popularized an aggressive STAGE 4 NED approach based on sequential single agent studies compared with historical controls, making their standard of care aggressive local-regional therapy followed by chemo and hormonal therapy (if w...

proviso. Since the relapse was greater than a year after start of A.I. one could consider reintroduction of an A.I. rather than Fulvestrant.

Fosladex plus ibrance