Adjuvant Therapy for Postmenopausal Women with Luminal B Breast Cancer

Classification of Risk

The patient presents with a high-risk tumor due to lymph node involvement with extracapsular extension, luminal B subtype (high Ki67 - 30%), and low progesterone receptor expression (5%) 3, 1
The presence of extracapsular extension in a 3 cm lymph node represents an additional unfavorable prognostic factor 1

A sequential regimen based on anthracycline followed by taxane is the standard treatment for patients with high-risk luminal B breast cancer 1, 2
The American Society of Clinical Oncology recommends anthracycline-based chemotherapy for patients with node-positive breast cancer 4
Preferred options include AC (doxorubicin and cyclophosphamide) followed by weekly paclitaxel, dose-dense AC followed by paclitaxel, or TAC (docetaxel, doxorubicin, and cyclophosphamide) 4

For postmenopausal patients, aromatase inhibitors (anastrozole, letrozole, or exemestane) are recommended as adjuvant therapy 1, 2, 5
The National Comprehensive Cancer Network recommends the use of aromatase inhibitors for 5 years as initial treatment 2, 5
Extended therapy beyond 5 years may be considered, although the benefit is minimal for the use of aromatase inhibitors for more than 5 years 2

There is no indication for a new surgical axillary approach for additional emptying, as an adequate axillary approach has already been performed with the removal of 7 lymph nodes 1, 6
The presence of only 1 positive lymph node, even with extracapsular extension, does not justify a new surgical axillary approach 6
Complementary treatment with axillary radiotherapy will be sufficient for local-regional control 1

Postoperative radiotherapy is strongly recommended after breast-conserving surgery 1
Irradiation of regional lymph nodes (including the supraclavicular fossa) is indicated due to axillary involvement 1, 7
Shorter fractionation schemes (15-16 fractions with a single dose of 2.5-2.67 Gy) are generally recommended 1