How have you been incorporating Abemaciclib into the adjuvant management of high risk node positive HR+ breast cancer?

To date, I have used local lab results for Ki-67 and had no issues with insurance coverage. Our breast team has otherwise been attempting to utilize abemacicilib in situations that meet the monarch-E protocol (Patients with four or more positive nodes, or one to three nodes and either tumor size ≥ 5 cm, histologic grade 3, or central Ki-67 ≥ 20%), with really the biggest challenge to-date being consideration of "how far out (from diagnosis) is too far out" to consider adding the abemacicilib. Again, our breast team discussed this early on, and we have tried to stay reasonably close to the protocol: within 16 months from the time of definitive breast cancer surgery OR up to 12 weeks of endocrine therapy.

For cases that fall outside of the pr...