What adjuvant systemic therapy do you recommend for a pre-menopausal patient with a localized recurrence of ER+PR+HER2- invasive ductal carcinoma while on adjuvant ovarian suppression with an aromatase inhibitor?  

This is a difficult clinical scenario. First, I would determine whether she was compliant with her medication. With the assumption that she was compliant, I would say that there is a paucity of data in this setting. The final analysis of the CALOR trial demonstrated that, after a median of 9 years, ...

I agree with the proposed plan to consider curative intent chemotherapy for local recurrence. However, I would consider changing her hormone therapy to a drug with a completely different mechanism of action such as tamoxifen as she may have an ESR mutation or some other biologic mechanism conferring...