Recent decades have brought meaningful improvements in outcomes for patients with metastatic hormone receptor–positive, ERBB2-negative breast cancer. Discovery of effective adjuncts to hormonal therapy has improved quality of life and survival in the endocrine-sensitive and resistant settings. Several randomized trials and meta-analyses demonstrate the benefit of modern hormonal therapy–based treatments over traditional cytotoxic chemotherapy approaches.1 Although practice guidelines routinely recommend initial hormone-based therapy,2,3 many clinicians and patients struggle to defer chemotherapy in those with symptomatic or high-burden disease. We assume that some patients might be better served by up-front chemotherapy, but which patients? Without predictive biomarkers, we are left with our clinical knowledge, experience, and intuition. Patients are left with uncertainty, doubt, and fear.
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Ballinger TJ, Smith ML, Miller KD. Evaluating the Clinical Utility of Circulating Tumor Cells in Metastatic Breast Cancer—Is Not Worse Good Enough? JAMA Oncol. 2021;7(1):30–31. doi:10.1001/jamaoncol.2020.5460
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