Would you consider adding adjuvant ribociclib for a patient who has already received 2 years of endocrine therapy and is eligible for ribociclib according to the NATALEE trial?  

Since the NATALEE trial excluded patients who received more than 12 months of neoadjuvant or adjuvant endocrine therapy, I would probably not consider ribociclib for your patient, as she is too far out from initiation of endocrine therapy.

Check out the rebuttal to this by Conforti and colleagues. (Conforti et al., PMID 40961402)

NATALEE Trial Overview Trial Name: NATALEE (New Adjuvant Trial With Ribociclib [LEE011]) Phase: III, randomized, open-label, multicenter Enrollment: 5,101 patients across 20 countries Sponsor: Novartis ClinicalTrials.gov ID: NCT03701334 Patient Population Eligibility: Adults with stage I...

Currently, there are insufficient data to support the efficacy or safety of starting ribociclib after 2 years of endocrine therapy have already been completed. That being said, recommendations for adjuvant CDK4/6 inhibitors should be individualized, but specifically, the clinical benefit of ribocicl...