How would you approach adjuvant treatment for a premenopausal woman with a large, lymph node positive HR+, Her2 negative lobular breast cancer?   

In pure or classical estrogen receptor positive lobular breast cancers neoadjuvant chemotherapy works very poorly (3% vs 15% pCR; Cristofanilli et al. J Clin Oncol 2005;23:41-8) and you are not likely to convert mastectomy to lumpectomy. I would strongly consider neoadjuvant endocrine therapy, espec...