What factors do you use to decide between ribociclib and abemaciclib for high risk HR+/HER2− early breast cancer?

For women who are eligible for both, we discuss both, but I am biased towards ribociclib for certain. The QOL issues we have had with abemaciclib in the adjuvant setting have been outrageous.

Despite best supportive care and dose adjustments, I have women severely limiting their daily activities aro...

I think either is ok. Things to consider:

1. Comorbidities. For example, I would avoid Abemaciclib in patients with active IBD and would avoid Ribociclib in patients with significant heart disease (especially if pre-existing prolonged QTc).
2. Abemaciclib is given at full dose (150 mg bid) for 2 years wh...

Both are great options in early-stage high-risk ER+ HER2- patients. Both NATALEE and monarchE clearly addressed risk in different early-stage breast cancer patient populations, and this must be factored in when making decisions. The guidelines note that both are options for high-risk node-positive p...

The final decision between these two agents would be dependent on patient comorbidities. However, for very high-risk node-positive monarchE-like patients (≥4 nodes, bulky/grade 3 residual disease) where GI tolerance is acceptable (especially given TRADE data), and there is no strong DVT risk, abemac...

I question the routine use of either medicine in the adjuvant setting. MonarchE and NATALEE trials each have significant limitations raising concerns over how to interpret the data. Both agents have significant toxicity profiles with unprecedented financial toxicity, and no OS benefit yet seen.

I wou...

This is an important question. Since we have no direct comparison studies, I do not have a specific recommendation that is evidence-based. Thus, for patients who would have met the eligibility criteria for either study, I am discussing both options. I then discuss duration, medication schedule, lab ...

MonarchE supports abemaciclib use in very high-risk patients, especially those with early recurrence risk.

NATALEE suggests ribociclib may benefit a wider population, including those with lower nodal burden but other high-risk features.

Treatment duration and toxicity profiles differ, which may influe...

The critiques below should be read by anyone considering using these agents in the adjuvant setting:

Tannock et al., PMID 40228181