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Team Strategies for Overcoming Challenges to Guideline-Concordant Care of High-Risk HR-Positive/HER2-Negative Early Breast Cancer

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This activity examines evidence-based selection and management of adjuvant systemic therapy for patients with high-risk HR-positive/HER2-negative early breast cancer, with emphasis on recurrence risk stratification, eligibility for CDK4/6 inhibitors, and treatment tolerability. The expert discussion highlights long-term distant recurrence risk after endocrine therapy and phase III data from monarchE and NATALEE, including survival, patient selection criteria, treatment duration, and distinct safety profiles for adjuvant abemaciclib and ribociclib. It also addresses emerging phase III evidence for the oral SERD giredestrant. Practical case-based scenarios highlight how anatomic stage, nodal status, tumor grade, Ki-67, genomic risk, BRCA status, guideline criteria, toxicity profiles, and patient preferences influence treatment choice, and additional content focuses on monitoring and managing adverse events to support dose optimization and adherence. 

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Registered Nurses: 1.00 Nursing contact hour

Physician Assistants: maximum of 1.00 hour of AAPA Category 1 CME credit

Pharmacists: 1.00 contact hour (0.1 CEUs)

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Nurse Practitioners/Nurses: 1.00 hour of pharmacotherapy credit

Released: September 01, 2026

Expiration: February 28, 2027

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Provided by National Comprehensive Cancer Network in collaboration with Decera Clinical Education.

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Supporters

This activity is supported by educational grants from Lilly and Novartis.

Lilly

Novartis

Partners

Decera Clinical Education

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Target Audience

This activity has been designed to meet the educational needs of oncologists, nurse practitioners, physician associates, oncology nurses, pharmacists, and other healthcare professionals involved in the care of patients with HR-positive/HER2-negative early breast cancer.

Program Learning Goal

This activity aims to improve learners’ knowledge and competence at integrating CDK4/6 inhibitors into practice to improve clinical outcomes in patients with HR-positive/HER2-negative early breast cancer.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Collaborate with multidisciplinary colleagues to identify each patient with HR-positive/HER2-negative EBC who is eligible for CDK4/6 inhibitor treatment

  • Recommend the optimal CDK4/6 inhibitor treatment for each patient with HR-positive/HER2-negative EBC in alignment with NCCN Guidelines, high-level evidence, and expert-recommended best practices

  • Support open and frequent patient-clinician communication to enable effective counseling on the benefits vs potential risks of adjuvant CDK4/6 inhibitor treatment, reporting of patient-felt toxicities, and screening for barriers to adherence/persistence

  • Implement proactive toxicity monitoring, dose modification, and supportive care to enable patient adherence and persistence to CDK4/6 inhibitor treatment for HR-positive/HER2-negative EBC

Financial Disclosures

It is the policy of NCCN that all planners, faculty, moderators, authors, reviewers, ​and anyone involved in the planning and delivery of NCCN continuing education activities are expected to disclose ALL financial relationships they have had in the past 24 months with ineligible companies. The ACCME Standards for Integrity and Independence require that individuals who refuse to provide this information will be disqualified from involvement in the planning and implementation of accredited continuing education presented by NCCN. NCCN identifies, mitigates, and discloses to learners all relevant financial relationships.​

In addition, all content has been reviewed to ensure education promotes safe, effective patient care and does not promote the products or services of an ineligible company. Content, including any presentation of therapeutic options, is fair, balanced, evidence-based, scientifically accurate, and free of commercial bias and marketing.

Definitions 
Ineligible Company: An ineligible company is any entity whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients. ​

Relevant Financial Relationships: Financial relationships of any dollar amount occurring within the past 24 months are defined as relevant if the educational content an individual can control is related to the business lines or products of an ineligible company. There is no minimum financial threshold. We ask for disclosure of ALL financial relationships with ineligible companies, regardless of the amount and regardless of the potential relevance of each relationship to the education.​

Faculty Disclaimers  
All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation for the tasks and methods of delivery.​

Faculty presentations may include discussion of off-label use. Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling or marketing.

The faculty listed below have the following relevant financial relationships with ineligible companies to disclose. All of the relevant financial relationships listed for these individuals have been mitigated.

Primary Author

Jame Abraham, MD, FACP, has no relevant financial relationships to disclose.

Instructions for Credit

Participation in this self-study activity should be completed in approximately 1 hour. To successfully complete this activity and receive credit, participants must follow these steps during the period from September 01, 2026, through February 28, 2027:

  1. Login or Sign Up for an account by clicking at the top of this page.
  2. Read the target audience, learning objectives, and faculty disclosures.
  3. View and study the content in its entirety.
  4. Submit answers to the posttest questions and evaluation questions online.

You must receive a test score of at least 65 and respond to all evaluation questions to receive a certificate. After submitting the evaluation, you may access your online certificate by selecting the certificate link on the confirmation page. Records of all CME/CE activities completed can be found on the "My Certificates" page. There are no costs/fees for this activity.

Format

This program has been made available online.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Additional Disclosures

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Generative artificial intelligence (AI) tools were used for revising or refining educational content. All AI-assisted content underwent human review, editing, and validation by qualified faculty and accredited education staff to ensure scientific accuracy, balance, and compliance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education.

Accreditation

Joint Accreditation Statement

In support of improving patient care, National Comprehensive Cancer Network (NCCN) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Physician Continuing Medical Education

NCCN designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

NCCN designates this educational activity for a maximum of 1 contact hour. This program offers 1 pharmacotherapeutic contact hour for nurses. 

Continuing Pharmacy Education

NCCN designates this knowledge-based continuing education activity for 1 contact hour (0.10 CEUs) of continuing education credit. UAN: JA4008196-0000-26-080-H01-P 

Type of Activity: Knowledge​

Upon successfully completing the post-test with a score of 65% or better and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 60 days.

Physician Associate Continuing Medical Education

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NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credit. Approval is valid until February 28, 2027. PAs should only claim credit commensurate with the extent of their participation.

American Board of Internal Medicine Maintenance of Certification

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Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 medical knowledge MOC point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregated participant data will be shared with the commercial supporters of this activity.

For ABIM MOC points, your information will be shared with the ABIM through NCCN's Joint Accreditation Program and Activity Reporting System (JAPARS). Please allow 6-8 weeks for your MOC points to appear on your ABIM records.

By sharing your Diplomate Board ID # and DOB, you are giving NCCN permission to use this information/data to report your participation to these Boards via the Joint Accreditation Program and Activity Reporting System (JA-PARS).