What is optimal endocrine therapy in a young, premenopausal women with ER/PR positive oligometastic breast cancer successfully treated with curative intent neoadjuvant chemo followed by surgery+RT to skeletal oligomet?

These cases are always important to understand what discussions were had up front with the patient and all members of the team regarding goals of care. It seems the patient was treated with "curative" intent; however, the likelihood that she has actually been cured of her disease is extremely low and it is important that the patient understands that she received chemo, surgery, and radiation for uncertain benefit. The endocrine therapy portion of her therapy will be the most important, and thus particularly after aggressive upfront therapy, I would favor optimization with an aromatase inhibitor along with ovarian suppression and a CDK4/6 inhibitor given improvement in progression free and overall survival in the metastatic setting.