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What neoadjuvant treatment is recommended for patients with HR-positive HER2-negative breast cancer

Recommendation 4.1. Neoadjuvant chemotherapy can be used instead of adjuvant chemotherapy in any patient with HR-positive, HER2-negative breast cancer in whom the chemotherapy decision can be made without surgical pathology data and/or tumor-specific genomic testing (Type: informal consensus; Evidence quality: low; Strength of recommendation: moderate). Recommendation 4.2. For postmenopausal patients with HR-positive/HER2-negative disease, neoadjuvant endocrine therapy with an aromatase inhibitor may be offered to increase locoregional treatment options. If there is no intent for surgery, endocrine therapy may be used for disease control (Type: evidence-based; benefits outweigh harms; Evidence quality: intermediate; Strength of recommendation: moderate). Recommendation 4.3. For premenopausal patients with HR-positive/HER2-negative early-stage disease, neoadjuvant endocrine therapy should not be routinely offered outside of a clinical trial (Type: evidence-based; benefits outweigh harms; Evidence quality: intermediate; Strength of recommendation: moderate).

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