I have a 21 year old female with a Stage III ER+/PR+, HER2+ FISH (equivocal) that has about 7 cm mass. Genetics with MSH6 VUS. PET showing single breast mass, left axillary LN, and 2 sub centimeter left internal mammary LN, no mets. Interestingly if our practice, we are using oncotype upfront on biopsy samples to give neoadjuvant chemotherapy if high. I am having her HER2 repeated as it was done at outside hospital. Having her get fertility preservation as well. She's very young and nervous about side effects of anthracyclines in long run which is reasonable. What would you use chemotherapy wise assuming she has oncotype that necessitates chemotherapy?
If Her2+, I would do TCHP neoadjuvantly; no need for anthracyclines for Her2+ anymore.If Her2-, I do think I'd recommend AC-T. She has T3N3 disease (with possible internal mammary LN involvement), so chemotherapy is definitely indicated, preferably neoadjuvantly (regardless of Oncotype score). Because of extensive LN involvement, I would definitely prefer anthracycline/taxane combination therapy, such as AC-T, because the addition of anthracyclines does impart an IDFS/OS benefit in this scenario. Honestly, for her, doesn't matter what Oncotype score is- she should get chemotherapy since she is premenopausal (RxPONDER).
