In the neoadjuvant setting, how would you treat a premenopausal woman with a 3 cm ER+, PR weakly positive, Her-2 negative, grade 3 breast cancer with clinical N1 node which shows basal type on Mammaprint?
What subsequent adjuvant therapy would you recommend?
Answer from: Medical Oncologist at Academic Institution
This patient has high risk features and would likely benefit from chemotherapy. Given positive hormone expression (even if basal molecular type by Mammaprint), she would not be eligible for KEYNOTE-522 study. Hence, I would not recommend pembrolizumab. If there are no significant risks for complicat...
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Answer from: Medical Oncologist at Community Practice
In addition to adjuvant/neo-adjuvant chemo with ddAC-T and hormonal therapy with OFS+AI, one could also consider adjuvant Abemaciclib per MonarchE study, given her N1 disease + grade 3 tumor.
MonarchE was an open-label, phase III study that included patients with HR+, HER2-, high-risk EBC, wh...
Answer from: Medical Oncologist at Academic Institution
For a patient such as described here, I would generally recommend neoadjuvant chemotherapy. At our institution, we would generally also proceed with a US-guided FNA, to confirm pathologically node involvement. She would then undergo appropriate locoregional therapy (i.e., surgery and quite likely ra...
Answer from: Medical Oncologist at Community Practice
Neoadjuvant chemo AC-T would be a good choice especially with biopsy proven node positive disease. She can be assessed for targeted/limited axillary dissection if she clears axilla radiographically and at clipped axillary node.