Would you consider neoadjuvant endocrine therapy instead of chemotherapy for a pre-menopausal patient with a node-positive, ER+PR+, lobular breast cancer?

You can consider neoadjuvant endocrine therapy (NET) for classical strongly ER/PR expressing lobular cancers in certain cases where there is a desire to delay surgery or the patient is not a candidate for chemotherapy. Usually the duration of therapy is for around 6 months as long as the patient is responding. Keep in mind though that a study from MD Anderson demonstrated that neoadjuvant chemotherapy in lobular cancers seldom increase the rate of breast conservation or altered the surgical plan. (Boughey Ann Surg Oncol. 2009) A study using the NCDB showed a small change in BCS rates with NET for ER+ tumors but this wasn't limited to lobular cancers (Chiba A, et al. Ann Surg Oncol. 2017).