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15 treatment settings, 13 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Surgery, radiation, endocrine therapy 5-10 years; chemotherapy if genomic risk high; abemaciclib or ribociclib adjuvant for high-risk.
A 21-gene test that tells most women with early hormone-positive breast cancer whether they can safely skip chemotherapy.
Abemaciclib was the first CDK4/6 inhibitor approved after surgery for high-risk hormone-positive breast cancer.
Ribociclib is the CDK4/6 inhibitor with the most consistent survival benefit, approved for a broad population of early breast cancer patients since 2024.
iDFS HR 0.68.
iDFS HR 0.75.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · 37-46% any grade; 19-32% grade 3-4 | 42% | 19% |
| Diarrhoea · 81-90% any grade; 8-20% grade 3 across trials | 85% | 8% |
| Infections · monarchE / MONARCH 2 | - | 3% |
| Venous thromboembolism · 2-5% across trials | - | 2% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutrophils decreased · NATALEE / MONALEESA-2 | 94% | 45% |
| ALT/AST increased (grade 3-4) · 8-11% across trials | - | 8% |
| Lymphocytes decreased · NATALEE / MONALEESA-2 | 97% | - |
| Leukocytes decreased · NATALEE / MONALEESA-2 | 95% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
CDK4/6 inhibitor + aromatase inhibitor or fulvestrant.
Palbociclib was the first CDK4/6 inhibitor (2015), and in 2026 became the first approved as maintenance in HER2-positive, hormone-positive breast cancer.
Ribociclib is the CDK4/6 inhibitor with the most consistent survival benefit, approved for a broad population of early breast cancer patients since 2024.
Abemaciclib was the first CDK4/6 inhibitor approved after surgery for high-risk hormone-positive breast cancer.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · PALOMA-2 with letrozole | 80% | 66% |
| Leukopenia · PALOMA-2 with letrozole | 39% | 25% |
| Infections · PALOMA-2 with letrozole | 60% | 7% |
| Anaemia · PALOMA-2 with letrozole | 24% | 6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutrophils decreased · NATALEE / MONALEESA-2 | 94% | 45% |
| ALT/AST increased (grade 3-4) · 8-11% across trials | - | 8% |
| Lymphocytes decreased · NATALEE / MONALEESA-2 | 97% | - |
| Leukocytes decreased · NATALEE / MONALEESA-2 | 95% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · 37-46% any grade; 19-32% grade 3-4 | 42% | 19% |
| Diarrhoea · 81-90% any grade; 8-20% grade 3 across trials | 85% | 8% |
| Infections · monarchE / MONARCH 2 | - | 3% |
| Venous thromboembolism · 2-5% across trials | - | 2% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Genotype-directed: capivasertib, inavolisib, alpelisib, everolimus; elacestrant/vepdegestrant if ESR1-mutant; gedatolisib.
Capivasertib (Truqap) is the first AKT inhibitor, for breast cancer with PI3K-pathway mutations and, since 2026, for prostate cancer with PTEN loss.
Inavolisib is a PI3K drug that also destroys the mutant protein, approved in 2024 with palbociclib and fulvestrant for PIK3CA-mutant breast cancer.
Elacestrant was the first oral oestrogen-receptor degrader (2023), for ESR1-mutant breast cancer detected by blood test.
Vepdegestrant is the first PROTAC ever approved (2026): a pill that tags the oestrogen receptor for destruction, for breast cancers with ESR1 mutations.
An intravenous drug that blocks the whole PI3K/mTOR pathway, approved in July 2026 for hormone-positive breast cancer.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Cutaneous adverse reactions · CAPItello-291 | 56% | 15% |
| Diarrhoea · CAPItello-291 | 77% | 12% |
| Fatigue · CAPItello-291 | 38% | 1.9% |
| Stomatitis · CAPItello-291 | 25% | 1.9% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
T-DXd (HER2-low/ultralow) before chemotherapy; sacituzumab govitecan or Dato-DXd after chemotherapy.
Trastuzumab deruxtecan (Enhertu) is the most successful ADC ever. It redefined HER2 by working in tumours with only tiny amounts of the protein, and in 2026 moved into early-stage breast cancer.
The first TROP2-targeted ADC. It delivers a strong chemotherapy directly to breast and bladder cancer cells and is now a first-line option in triple-negative breast cancer.
Datopotamab deruxtecan (Datroway) is the second TROP2 ADC and shares Enhertu's payload. In 2026 it became a first-line option for triple-negative breast cancer patients who cannot receive immunotherapy.
PFS HR 0.62.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 18% |
| Nausea · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Anaemia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Fatigue · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia (grade 3 or higher) · ASCENT, sacituzumab arm; 33 percent with chemotherapy | - | 51% |
| Neutropenia · ASCENT, Trodelvy arm, n=258 | 78% | 49% |
| Diarrhoea · ASCENT, Trodelvy arm, n=258 | 59% | 11% |
| Diarrhoea (grade 3 or higher) · ASCENT; below 1 percent with chemotherapy | - | 10% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Stomatitis · TROPION-Breast01, n=360 | 59% | 7% |
| Fatigue · TROPION-Breast01, n=360 | 44% | 4.2% |
| Nausea · TROPION-Breast01, n=360 | 56% | 1.4% |
| Keratitis · TROPION-Breast01, n=360 | 24% | 1.1% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Mammography ± tomosynthesis; supplemental MRI for dense breasts or high risk; core biopsy with ER/PR/HER2/Ki-67; AI-assisted reading being deployed.
Low-dose breast X-ray used for screening. Newer 3D versions find more cancers with fewer false alarms.
Software that reads scans alongside radiologists, catching cancers earlier and predicting who is at risk.
Histopathology means looking at cancer cells under a microscope, and immunohistochemistry stains them for specific proteins. Together they are still the foundation of every diagnosis.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Genomic assay (Oncotype DX RS ≤25 node-negative or postmenopausal 1-3 nodes; MammaPrint low risk) → endocrine therapy alone; premenopausal RS 16-25 or high clinical risk → chemotherapy or OFS-based escalation.
A 21-gene test that tells most women with early hormone-positive breast cancer whether they can safely skip chemotherapy.
A 70-gene test that tells whether an early breast cancer is genomically low or high risk, used to decide who can skip chemotherapy.
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
No chemo benefit postmenopausal; iDFS HR 0.60 with chemo premenopausal.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
Postmenopausal: aromatase inhibitor 5-10 years (or tamoxifen → AI switch). Premenopausal: tamoxifen 5-10 years; add OFS (+ AI or tamoxifen) for higher-risk or chemotherapy-treated women (SOFT/TEXT).
Daily pills that stop the body making oestrogen after menopause, the backbone of hormone therapy for most breast cancers.
The original targeted cancer drug (1977): a pill that blocks oestrogen's effect on breast cancer and halves recurrence, still essential for premenopausal women.
Monthly or 3-monthly injections that switch off the ovaries, letting premenopausal women use aromatase inhibitors and lowering recurrence in higher-risk cases.
Exemestane + OFS: DFS and DRFI improved; no OS difference at 12 years.
Add these to your appointment list, or take the full question set for this cancer.
Abemaciclib 2 years for node-positive high-risk (monarchE); ribociclib 3 years for stage II-III including node-negative high-risk (NATALEE). Palbociclib not effective (PALLAS/PENELOPE-B). Olaparib 1 year if gBRCA (OlympiA).
Abemaciclib was the first CDK4/6 inhibitor approved after surgery for high-risk hormone-positive breast cancer.
Ribociclib is the CDK4/6 inhibitor with the most consistent survival benefit, approved for a broad population of early breast cancer patients since 2024.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
iDFS HR 0.68.
iDFS HR 0.75.
PALLAS iDFS HR 0.96; PENELOPE-B iDFS HR 0.93; both null.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · 37-46% any grade; 19-32% grade 3-4 | 42% | 19% |
| Diarrhoea · 81-90% any grade; 8-20% grade 3 across trials | 85% | 8% |
| Infections · monarchE / MONARCH 2 | - | 3% |
| Venous thromboembolism · 2-5% across trials | - | 2% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutrophils decreased · NATALEE / MONALEESA-2 | 94% | 45% |
| ALT/AST increased (grade 3-4) · 8-11% across trials | - | 8% |
| Lymphocytes decreased · NATALEE / MONALEESA-2 | 97% | - |
| Leukocytes decreased · NATALEE / MONALEESA-2 | 95% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Extended AI to 10 years for higher-risk (MA.17R, NSABP B-42); adjuvant giredestrant positive in lidERA (2025, not yet approved); CAMBRIA (camizestrant) and EMBER-4 (imlunestrant) ongoing.
Giredestrant is Roche's oral SERD: it failed to beat an aromatase inhibitor in first-line metastatic disease but succeeded after surgery and after CDK4/6 failure.
iDFS ~30% relative reduction (HR ~0.70).
No headline result recorded yet.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
CDK4/6 inhibitor + aromatase inhibitor (or fulvestrant): ribociclib or abemaciclib preferred where OS data are valued; palbociclib acceptable. Premenopausal: add OFS. For relapse on/within 12 months of adjuvant ET with PIK3CA mutation: inavolisib + palbociclib + fulvestrant (INAVO120).
Ribociclib is the CDK4/6 inhibitor with the most consistent survival benefit, approved for a broad population of early breast cancer patients since 2024.
Abemaciclib was the first CDK4/6 inhibitor approved after surgery for high-risk hormone-positive breast cancer.
Palbociclib was the first CDK4/6 inhibitor (2015), and in 2026 became the first approved as maintenance in HER2-positive, hormone-positive breast cancer.
Inavolisib is a PI3K drug that also destroys the mutant protein, approved in 2024 with palbociclib and fulvestrant for PIK3CA-mutant breast cancer.
OS 63.9 vs 51.4 months, HR 0.76.
PFS HR 0.54; OS 66.8 vs 53.7 months, HR 0.80 (NS).
PFS HR 0.56; OS HR 0.96 (NS).
PFS 15.0 vs 7.3 months, HR 0.43; OS 34.0 vs 27.0 months, HR 0.67.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutrophils decreased · NATALEE / MONALEESA-2 | 94% | 45% |
| ALT/AST increased (grade 3-4) · 8-11% across trials | - | 8% |
| Lymphocytes decreased · NATALEE / MONALEESA-2 | 97% | - |
| Leukocytes decreased · NATALEE / MONALEESA-2 | 95% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · 37-46% any grade; 19-32% grade 3-4 | 42% | 19% |
| Diarrhoea · 81-90% any grade; 8-20% grade 3 across trials | 85% | 8% |
| Infections · monarchE / MONARCH 2 | - | 3% |
| Venous thromboembolism · 2-5% across trials | - | 2% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · PALOMA-2 with letrozole | 80% | 66% |
| Leukopenia · PALOMA-2 with letrozole | 39% | 25% |
| Infections · PALOMA-2 with letrozole | 60% | 7% |
| Anaemia · PALOMA-2 with letrozole | 24% | 6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Serial ctDNA; on emergent ESR1 mutation before radiographic progression, switch AI → camizestrant and continue the CDK4/6 inhibitor (SERENA-6; accelerated approval 4 Sep 2026).
Camizestrant is an oral oestrogen-receptor degrader approved in September 2026 for a new kind of decision: switching treatment when a blood test shows resistance developing, before the cancer visibly grows.
PFS 16.0 vs 9.2 months, HR 0.44.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
ESR1-mutant: elacestrant, imlunestrant (± abemaciclib), or vepdegestrant. PIK3CA/AKT1/PTEN: capivasertib + fulvestrant; alpelisib + fulvestrant. Any genotype after CDK4/6: gedatolisib + palbociclib + fulvestrant (PIK3CA-wild-type, 2026); everolimus + exemestane or giredestrant (filed); abemaciclib switch (postMONARCH, modest).
An intravenous drug that blocks the whole PI3K/mTOR pathway, approved in July 2026 for hormone-positive breast cancer.
Elacestrant was the first oral oestrogen-receptor degrader (2023), for ESR1-mutant breast cancer detected by blood test.
Imlunestrant is Lilly's oral oestrogen-receptor degrader, approved in 2025 for ESR1-mutant breast cancer and shown to work with abemaciclib regardless of mutation.
Vepdegestrant is the first PROTAC ever approved (2026): a pill that tags the oestrogen receptor for destruction, for breast cancers with ESR1 mutations.
Capivasertib (Truqap) is the first AKT inhibitor, for breast cancer with PI3K-pathway mutations and, since 2026, for prostate cancer with PTEN loss.
PFS HR 0.62 (ESR1-mutant, monotherapy); HR 0.57 (combination vs monotherapy).
PFS HR 0.55 in ESR1-mutant.
PFS HR 0.57 in ESR1-mutant; ITT not significant.
PFS HR 0.60 overall; HR 0.50 in AKT-pathway-altered.
PFS 11.0 vs 5.7 months, HR 0.65 (PIK3CA-mutant).
PFS HR 0.56 (ITT); HR 0.38 (ESR1-mutant).
PFS 6.0 vs 5.3 months, HR 0.73.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Cutaneous adverse reactions · CAPItello-291 | 56% | 15% |
| Diarrhoea · CAPItello-291 | 77% | 12% |
| Fatigue · CAPItello-291 | 38% | 1.9% |
| Stomatitis · CAPItello-291 | 25% | 1.9% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
HER2-low or ultralow (~60%): T-DXd (DESTINY-Breast06 chemotherapy-naive; DESTINY-Breast04 after chemotherapy). HER2-zero: sacituzumab govitecan or Dato-DXd after chemotherapy (TROPiCS-02, TROPION-Breast01).
Trastuzumab deruxtecan (Enhertu) is the most successful ADC ever. It redefined HER2 by working in tumours with only tiny amounts of the protein, and in 2026 moved into early-stage breast cancer.
The first TROP2-targeted ADC. It delivers a strong chemotherapy directly to breast and bladder cancer cells and is now a first-line option in triple-negative breast cancer.
Datopotamab deruxtecan (Datroway) is the second TROP2 ADC and shares Enhertu's payload. In 2026 it became a first-line option for triple-negative breast cancer patients who cannot receive immunotherapy.
PFS HR 0.62.
OS HR 0.64.
OS 14.4 vs 11.2 months, HR 0.79.
PFS HR 0.63; OS HR 1.01.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 18% |
| Nausea · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Anaemia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Fatigue · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia (grade 3 or higher) · ASCENT, sacituzumab arm; 33 percent with chemotherapy | - | 51% |
| Neutropenia · ASCENT, Trodelvy arm, n=258 | 78% | 49% |
| Diarrhoea · ASCENT, Trodelvy arm, n=258 | 59% | 11% |
| Diarrhoea (grade 3 or higher) · ASCENT; below 1 percent with chemotherapy | - | 10% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Stomatitis · TROPION-Breast01, n=360 | 59% | 7% |
| Fatigue · TROPION-Breast01, n=360 | 44% | 4.2% |
| Nausea · TROPION-Breast01, n=360 | 56% | 1.4% |
| Keratitis · TROPION-Breast01, n=360 | 24% | 1.1% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Sequential single-agent chemotherapy (capecitabine, taxanes, eribulin, vinorelbine); olaparib/talazoparib if gBRCA; clinical trials; supportive and palliative care integrated early.
A microtubule poison discovered in the Pacific yew tree, among the most used chemotherapies in breast, lung, and ovarian cancer.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
Talazoparib is a PARP inhibitor that traps PARP on DNA about 100 times more strongly than olaparib, which is why it works at a 1 mg daily dose. It is approved for germline BRCA-mutant HER2-negative breast cancer and, with enzalutamide, for HRR-mutant castration-resistant prostate cancer; anaemia is its dominant side effect.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Bisphosphonate or denosumab for bone metastases and AI-induced bone loss; adjuvant bisphosphonates in postmenopausal women; exercise, cardio-oncology, and adherence support.
Structured exercise during and after treatment, which the CHALLENGE trial showed improves survival in colon cancer.
Cardio-oncology builds heart risk assessment, monitoring and prevention into cancer care so patients can finish curative treatment without trading cancer for heart failure. It targets anthracycline and trastuzumab damage, checkpoint-inhibitor myocarditis and radiation heart disease using echocardiography, troponin tests and protective drugs; specialist clinics are concentrated in large centres.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.