High-risk early HR-positive breast cancer: lines of therapy
6 standard-of-care settings across 2 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Adjuvant CDK4/6 inhibitor | Abemaciclib for two years (monarchE, node-positive high-risk disease) or ribociclib for three years (NATALEE, stage II to III) alongside the aromatase inhibitor. | 93 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Deciding on chemotherapy | Genomic assay on node-negative and one to three node-positive tumours; chemotherapy for a high recurrence score, for premenopausal women with node-positive disease and a score up to 25, and for clinically high-risk tumours without a low genomic score. | 89 | ||
| All comers | Local therapy | Breast-conserving surgery with hypofractionated whole-breast radiotherapy or mastectomy, sentinel node biopsy, and regional nodal irradiation when nodes are involved. | 68 | ||
| All comers | Bone protection | Zoledronic acid or denosumab during aromatase inhibitor therapy in postmenopausal women reduces fractures, and bisphosphonates also reduce bone recurrence. | 83 | ||
| BRCA / HRD | Germline BRCA carriers | One year of adjuvant olaparib after chemotherapy for high-risk disease (OlympiA). | 94 | ||
| HR-positive | Endocrine therapy | Aromatase inhibitor for postmenopausal women; tamoxifen, or ovarian function suppression with an aromatase inhibitor for premenopausal women at higher risk (SOFT and TEXT); five years, extended to seven to ten in node-positive disease. | 93 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.