Breast cancer
INACTIVE --- Adjuvant systemic treatment of luminal A/B early breast cancer

Charlotta (43 years old)

Charlotta is a 43-year-old tour guide in Stockholm and loves to show the hidden charms of Sweden’s capital to tourists. Recently, she was diagnosed with early breast cancer following a screening mammography.

Assessment summary

  • No relevant medical history or family history of cancer
  • Premenopausal, regular menstrual cycles. Nulliparous (G0P0)
  • Stage and tumour biology (core biopsy) at diagnosis:
    • cT2N0M0
    • G2, invasive carcinoma of no special type, ER 100%, PgR 90%, HER2 negative (IHC 0), Ki67 25%
  • Breast conserving surgery with oncoplastic techniques + SLNB
  • Pathology report:
    • G2 bifocal invasive carcinoma, 20 mm largest foci
    • Intermediate grade DCIS 15%
    • Lymphovascular invasion present. No perineural invasion.
    • R0 resection (free margins)
    • 1 involved sentinel lymph node (1/4 sn)
    • pT1c(m)N1a(sn) cM0
  • Multidisciplinary board meeting
    • Gene expression profiling: luminal B intrinsic subtype, high risk of recurrence (MammaPrint Index: -0.115; average 10-year risk of recurrence if untreated: 29%)  
    • Adjuvant chemotherapy, followed by RT and endocrine therapy

Which endocrine treatment option would you choose for this patient?