Would you send Oncotype for pre-menopausal women with HR+, HER2(-) breast cancer with a small tumor (pT1b) and micrometastatic LN involvement or recommend adjuvant chemotherapy without sending Oncotype?

That is a very good question, especially considering that the RxPONDER trial showed benefit from chemotherapy in pre-menopausal women with 1-3 lymph nodes involved by breast cancer. However, this trial excluded patients who had micro-metastatic disease as the only nodal involvement, so we can't appl...

The NCCN recommends that for premenopausal patients with HR-positive, HER2-negative breast cancer and pN1mi (micrometastatic lymph node involvement), a gene expression assay should be considered to assess prognosis when the patient is a candidate for chemotherapy. Importantly, the NCCN algorithm gro...