How to treat lobular cancer in the adjuvant setting?

PURPOSE OF REVIEW: The aim of this review is to understand the clinical decision- making process for the management of patients with early invasive lobular breast cancer (ILC), thereby orienting clinicians across large areas of uncertainties and extrapolations. RECENT FINDINGS: The analysis of the principal evidence on the management of ILC, assessing the role and benefit of systemic treatments in the curative setting, have shed the light on the opportunity to escalate and de-escalate systemic therapies for ILC patients, based on the risk of recurrence and the intrinsic value of the treatments. To refine the selection of the patients most likely to benefit from escalated systemic treatments, the role of genomic tools in ILC has been surveyed. Eventually, an overview of the ongoing clinical studies for early lobular tumors has been extracted. SUMMARY: The review identifies large areas of uncertainties and unmet needs for the management of lobular cancer, urging the implementation of clinical studies appropriately designed, tailoring this subgroup of breast cancer patients. As a distinct biological and clinical entity, areas for improvement have been suggested, to support the formulation of controlled studies and better inform clinical decisions based on quality evidence.