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 guide...

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.