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

Vera (37 years old)

Vera, 37 years old, works fulltime in a magazine store. During the weekend, she often loses track of time while she is reading the latest gossip of celebrities. She was diagnosed with luminal B-like cT2N1M0 breast cancer after reporting a palpable lump in her right axilla.

Assessment summary

  • No relevant medical history
  • Premenopausal. Nulliparous (G0P0)
  • Genetic counselling + testing (positive family history): no BRCA1/2 germline mutations
  • Tumour biology (core biopsy from breast): G2, invasive carcinoma of no special type, ER 100%, PgR 10%, HER2 negative (IHC 2+, SISH negative), Ki67 50%
  • Lymph node core biopsy: positive for macrometastases


Treatment & follow-up

  • Fertility counselling: cryopreservation of oocytes
  • Echocardiogram: no structural or functional cardiac abnormalities
  • Pretreatment staging with breast MRI and localisation of tumour
  • Neoadjuvant chemotherapy: dose-dense EC-100 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 complete response in axilla (ycT1cN0)
  • 3 weeks later: breast conserving surgery with minor reconstructive techniques and limited ALND
    • 19 mm foci, G2, invasive carcinoma no special type
    • Lymphovascular invasion
    • R0 resection
    • 1 macrometastasis and 1 micrometastasis (2/6 lymph nodes)
    • ypT1cN1a

Which systemic treatment option would you choose for this patient?