What adjuvant chemotherapy would you recommend in a premenopausal patient with pT1cN1 HR+ breast cancer who previously received an anthracycline and cyclophosphamide 30 years prior?  

I would defer anthracycline regimens since the risk of cardiomyopathy increases after cumulative dose doxorubicin exceeds 400-450 mg/m2. Her prior exposure to alkylating agents also puts her at risk for secondary MDS from cyclophosphamide which is pretty much present in all modern chemotherapy regim...

With the Oncotype of 28 her absolute benefit from adjuvant chemotherapy is uncertain, but accepting that giving her chemo is the SOC, but would avoid the slight risk of cardiotoxicity from re-exposure to an anthracycline even all these years later, and in the ABC combined analysis the benefit of add...