What chemotherapy regimen would you recommend for high risk ER+/Her2- LN negative breast cancer with high genomic risk disease?

For the patient described, with high genomic risk but otherwise good-risk features (ER positive, HER2 negative, node negative) I would recommend TC x 4 cycles as reported in Jones et al (JCO 2009, 27:1177). The use of anthracycline plus taxane adds benefit overall as shown in the ABC trials, but for an ER positive, node negative cancer the minimal benefit does not outweigh the increase in potential long-term risk of cardiac toxicity and hematological malignancy.

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