With the intent for cure, what neoadjuvant therapy would you give a patient with only chest wall recurrence 10 years after an advanced breast cancer was managed with mastectomy, ddAC and T, and 5 years of adjuvant endocrine therapy?

A chest wall recurrence is associated with high risk of metastatic disease either at time of diagnosis of the chest wall recurrence or over the next 5 years. Women who develop chest wall recurrences should be restaged. The approach to an isolated chest wall recurrence in this case is surgery with clear margins, radiation if no prior radiation was given, and endocrine therapy. The fact there was a 5-year disease-free interval predicts for endocrine sensitivity. One can either re-treat with the same endocrine or switch a different endocrine. For example, if the first endocrine therapy was tamoxifen one could switch to an aromatase inhibitor. Primarily small retrospective studies show 5-year disease-free survival from the time of chest recurre...