What factors influence your decision regarding whether to administer a dose-dense chemotherapy regimen in the adjuvant setting to patients with hormone-receptor postive disease?

Many of the studies included in the analyses treated ER+ cases that we would call lower risk using modern genomic testing with adjuvant chemotherapy. So the observed effect of chemotherapy on recurrence and OS in ER+ disease can vary from study to study, depending on the numbers of low vs high risk luminal cases in the sample. The OS effect of chemo can also be harder to see in ER+ cases that tends to skew towards older populations with more competing risks for death. At our center, we usually prioritize using AC-T over TC for higher risk ER+ cases (i.e. N2-3, low ER expressors) based on the ABC trials. When we do AC in these cases, we typically do DD AC w growth factor support.

The disparate results in the two meta-analysis can also be explained by the larger numbers in the current meta-analysis. Moreover, studies with longer follow up are needed in HR-positive breast cancer to evaluate the efficacy of a given chemotherapy with its ovarian function effect.