Case 2: Lower Nodal Burden Disease

A second case highlights a postmenopausal patient with lower nodal burden but biologically high-risk HR-positive, HER2-negative breast cancer. The discussion examines how tumor size, grade, Ki-67, and genomic risk inform treatment decisions when nodal involvement is limited. The faculty emphasize the central role of endocrine therapy while exploring when adjuvant CDK4/6 inhibition may be appropriate. Patient adherence, toxicity tolerance, monitoring requirements, and quality-of-life considerations are all weighed. This case underscores the nuance required when multiple effective treatment options are available.