What is your adjuvant treatment approach to patients with strongly hormone-receptor positive breast cancer who have minimal response to neoadjuvant chemotherapy?

Many patients with strongly hormone receptor-positive tumors, including lobular cancers, may not respond to chemotherapy either clinically or by pathological response. In these patients, lack of response may not correlate with a worse long-term outcome to the same extent that it would in triple negative or HER2+ cases, or even in more rapidly proliferating tumors and/or those with low ER/PR content. I therefore would base further therapy (such as the use of additional post-operative chemotherapy...

There are a lot of misconceptions regarding the value of neoadjuvant chemotherapy in ER-positive breast cancer. Downstaging disease to improve operability and breast conservation is one, but sometimes the objective is not clear. Response is low and value of neoadjuvant chemotherapy should be weighed carefully and objectives defined upfront. Chemotherapy may not be appropriate for many patients with ER-positive breast cancer based on predictive genomics (such as RS testing for example where most ...