Practical tools to facilitate the choice of adjuvant systemic therapy for resectable luminal HER2-negative breast cancer

Abstract

Luminal HER2-negative breast cancer accounts for about 60-70% of all cases of this disease. The choice of adjuvant systemic therapy for patients with operable luminal HER2-negative breast cancer, especially the prescription of adjuvant chemotherapy and ovarian suppression, is one of the most complex and controversial issues. The reasons for this are the pronounced heterogeneity of luminal breast cancer, the absence of clear markers of chemosensitivity, as well as hormone resistance of the tumor in some patients. Genetic tests have become a great help in resolving this issue in a number of foreign countries, allowing in each specific case to assess the risk of relapse of the disease and the need to prescribe more aggressive adjuvant drug therapy, however, they are not yet available to Russian oncologists. However, even in the absence of the ability to use such tests, we have tools that can significantly facilitate decision-making on the choice of adjuvant treatment for operable luminal HER2-negative breast cancer. As alternative tools, the article discusses a calculator for estimating the risk of recurrence based on clinicopathological tumor characteristics, preoperative test hormonal therapy with aromatase inhibitors for postmenopausal patients, and the composite progression risk index for premenopausal patients. All of these tools are available and can be used to guide adjuvant systemic treatment.