Adjuvant Chemotherapy Decisions in Clinical Practice for Early-Stage Node-Negative, Estrogen Receptor–Positive, HER2-Negative Breast Cancer: Challenges and Considerations

Decisions regarding adjuvant chemotherapy for patients with estrogen receptor (ER)–positive HER2-negative lymph node–negative breast cancer have traditionally relied on clinical and pathologic parameters. However, the molecular heterogeneity and the complex tumor genome demand more sophisticated approaches to the problem. Several multigene-based assays have been developed to better prognosticate the risk of recurrence and death and predict benefit of therapy in this patient population. Oncologists are often faced with the challenge of incorporating these various complex genome-based biomarkers along with the traditional biomarkers in clinical decision-making. The NCCN Clinical Practice Guidelines in Oncology for Breast Cancer are helpful in providing a general recommendation. However, uncertainty remains in the absence of definitive data for various clinical scenarios. This report presents a case of a postmenopausal woman with stage I breast cancer that is low-grade and ER-rich, and has an intermediate Oncotype DX recurrence score of 28.

Target Audience

This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Describe the rationale for the management methods used in this case presentation
  • Describe the ideal treatment with adjuvant chemotherapy for patients with estrogen receptor (ER)–positive HER2-negative lymph node–negative breast cancer
Additional information

No commercial support was received for this article.

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
Course expires: 

Gayathri Nagaraj, MD
Division of Medical Oncology and Hematology
Loma Linda University
Loma Linda, California

Cynthia X. Ma, MD, PhD
Section of Breast Oncology, Division of Oncology, Department of Medicine
Washington University School of Medicine
St. Louis, Missouri

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician


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