A 43-year-old Latina woman comes to the office for a follow-up evaluation following a recent diagnosis and treatment of breast cancer. The biopsy of the cancer demonstrated an estrogen receptor–positive, progesterone receptor–positive, HER2-negative, grade 2 invasive ductal carcinoma of the left breast. After the biopsy she agreed to surgery, adjuvant chemotherapy, and radiation therapy. She has come for her first post radiation visit. She currently takes no medications and is premenopausal.
On examination, her vital signs are in normal limits. Inspection of the chest reveals well-healed incisions of the left breast and left axilla. She currently has no lymphadenopathy and no right breast masses. The rest of the exam is unremarkable.
Results of a complete blood count and serum chemistry panel are normal.
Which of the following is the most appropriate therapy?
A. Start the patient on Exemestane alone
B. Start the patient on Tamoxifen alone
C. Maintenance chemotherapy with oral capecitabine
D. Start the patient on Prembrolizumab
E. No additional adjuvant therapy
Reference:
Burstein HJ, Temin S, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol. 2014 Jul 20;32(21):2255-69. PMID: 24868023