Navigating Treatment Decisions in Early-Stage Hormone Receptor-Positive Breast Cancer

Treating patients with early-stage hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer is increasingly complex, driven by a growing array of therapeutic options, heterogeneous clinical benefit across patient subgroups, and the risk of treatment-related and financial toxicity. Major advances in tumor biology-guided care have improved risk stratification and helped identify patients most likely to benefit from chemotherapy, especially with the use of genomic assays. In this article, we examine key challenges and ongoing controversies in managing this breast cancer subtype, including the use of genomic assays in premenopausal women with node-positive disease, tailoring treatment in locally advanced tumors with favorable biology, and the current and emerging roles of circulating tumor DNA as a prognostic and predictive biomarker.