How do you approach recurrent, localized HR+, HER2- breast cancer in a patient who has progressed on exemestane (and previously on letrozole and tamoxifen)?  

If the tumor is not resectable, I would use fulvestrant and a CDK inhibitor; but if the ER/PR expression is low, I might consider pre-operative chemotherapy using a standard adjuvant chemotherapy regimen—most likely AC-T. If the tumor is resectable (or has been resected), then I would use adj...

It depends on why this patient was on exemestane and if the tumor is resectable. - if she was on exemestane because the cancer had previously recurred locally while on adjuvant endocrine therapy, then I would suggest the following: rule-out systemic metastases with staging scans; if no distant dise...