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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 is available for 1.00 CME/CE credit(s).

Released: September 01, 2026

Expiration: February 28, 2027

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1 Pre Assessment 2 Video 3 Post Assessment 4 Evaluation 5 Credit

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. 

Jame Abraham
Jame Abraham, MD, FACP
Strategies for HRpos HER2neg EBC

Pre Assessment

Assess your current knowledge and clinical approach before beginning your video.
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1.

How many people with breast cancer do you provide care for in a typical month?

2.

For those who practice in academic or community settings, please indicate your practice setting:

3.

In your clinical practice, which of the following best describes your approach to sharing patient-directed educational resources, such as the NCCN Patient Guidelines, when initiating and treating patients with adjuvant CDK4/6 inhibitor therapy?

4.

Patient Case 1: Woman With Grade 3 ILC and 2 Positive Nodes



  • A 58-yr-old woman who is postmenopausal presents with a 3.5-cm right breast mass with  1 suspicious node

  • Initial breast biopsy reveals ILC, grade 3, with the following biomarkers

    • ER 80%, PgR 30%, HER2- by IHC



  • Fine-needle aspiration of a palpable right axillary lymph node reveals adenocarcinoma of the breast

  • BRCA testing: negative

  • Patient undergoes right breast lumpectomy with SLNB

  • Right lumpectomy specimen reveals a 4-cm ILC with 2/3 positive nodes (T2N1); Oncotype Dx RS 26

  • She completed TC x 4 cycles, followed by adjuvant radiation

  • She returns to the clinic now to discuss continued adjuvant treatment

In addition to extended-duration adjuvant endocrine therapy, what additional systemic therapy would be an appropriate treatment for this patient?

How confident are you in your answer?
5.

Which node-negative patient meets NCCN high-risk criteria for adjuvant ribociclib plus endocrine therapy?

How confident are you in your answer?
6.

Patient Case Continued: Woman on Adjuvant Abemaciclib With Diarrhea



  • 58-yr-old postmenopausal woman with T2N1 high grade invasive HR+/HER2- breast cancer started adjuvant abemaciclib 2 mo ago

  • She calls to report side effects including 6-8 episodes a day of diarrhea that is difficult to predict despite taking as-needed antidiarrheal medication

  • She says her weight is stable and that she is eating and drinking without problems

  • She also noted fatigue despite adequate sleep and is having trouble returning to work as a result

  • You ask her to hold abemaciclib until her symptoms are resolving

What additional counseling would you provide for this patient as the most appropriate next step in her treatment?

How confident are you in your answer?
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