Would you offer adjuvant abemaciclib to node-positive patients with low ER expression?

This tumor is likely biologically similar to a triple negative tumor, thus it is not surprising that it has a high Ki67. More information is really needed on if/what neoadjuvant therapy this patient received to better answer this question.

Although both KEYNOTE-522 and monarchE use the ASCO-CAP guidelines to define ER positivity or negativity, in general, I likely would have considered this patient for neoadjuvant chemotherapy with pembrolizumab, followed by adjuvant pembrolizumab and consideration of capecitabine for residual disease, followed by endocrine therapy. In that approach/scenario and landscape, I am less enthusiastic about abemaciclib.

If this patient went to surgery upfront and assuming they received adjuvant chemotherapy, they t...

The monarchE trial enrolled patients with ER or PR positive tumors by IHC according to ASCO 2010 guidelines. Based on those, this patient would qualify as HR+, node positive with a Ki67 >20%, and would consider offering adjuvant abemaciclib.

No.