Case 1 - Individualizing Adjuvant Therapy in a Premenopausal Patient With High-Risk Features

The faculty present the first case, a premenopausal woman with hormone receptor-positive, HER2-negative breast cancer who received neoadjuvant chemotherapy and was found to have residual invasive disease with multiple involved nodes, high-grade histology, and an elevated proliferation index. She has completed radiation, is preparing to begin endocrine therapy, and while motivated to pursue intensive treatment, she voices concerns about long-term tolerability and maintaining quality of life while working. The panel discusses how to contextualize her recurrence risk for her and outlines a stepwise approach to layering ovarian suppression, aromatase inhibitor therapy, and a CDK4/6 inhibitor over time rather than initiating everything at once. The faculty then address the management of ovarian function in a patient likely rendered menopausal by chemotherapy, weighing surgical oophorectomy against ongoing suppression and considering how hormone levels might be monitored. The segment illustrates how patient preference, treatment burden, and the sequencing of adjuvant therapy intersect in a high-risk premenopausal patient.