Breast cancer
Adjuvant systemic treatment of luminal A/B early breast cancer in premenopausal women

Uma (39 years old)

Uma is a 39-year-old speech therapist with an extra job as a tutor on Saturdays. On Sundays, she enjoys cycling with her best friends. She was diagnosed with luminal B-like cT2N1M0 breast cancer after reporting a palpable lump in her right axilla.

Assessment summary

  • Premenopausal
  • No relevant medical history
  • Genetic counselling + testing (positive family history): pathogenic BRCA2 germline mutation
  • Stage and tumour biology (core biopsy) at diagnosis:
    • cT2N1M0
    • G3, invasive carcinoma of NST, ER 90%, PgR 30%, HER2 IHC 0, Ki67 30%

Treatment & follow-up

  • Pretreatment staging with breast MRI and marking of tumour
  • Neoadjuvant chemotherapy: dose-dense EC q2w with G-CSF support followed by dose-dense paclitaxel q2w
  • Breast MRI at post-neoadjuvant therapy:
    • Partial response in breast (19 mm nodule) and stable disease in axilla (ycT1cN1)
  • 3 weeks later: BCS with minor reconstructive techniques and ALND
  • Pathology report:
    • 19 mm foci, G3, invasive carcinoma of NST, ER 90%, PgR 30%, HER2 IHC 0, Ki67 30%
    • LVI present, no perineural invasion
    • R0 resection (free margins)
    • 1 macrometastasis and 1 micrometastasis (2/11 lymph nodes)
    • ypT1cN1a
  • Multidisciplinary board meeting: postoperative RT and systemic therapy 

Which of the following systemic treatment options would you choose for this patient?