Logo Image

My Treatment Approach to HR-Positive, HER2-Negative Early Breast Cancer: Optimizing CDK4/6 Inhibitor Use in Clinical Practice

2 experts are featured in this series

EP. 1: Defining High-Risk HR+/HER2− Early Breast Cancer for Adjuvant CDK4/6 Therapy

ByRuta Rao, MD ,Eric Winer, MD

The discussion opens with an overview of the evolving treatment landscape for patients with high-risk HR-positive/HER2-negative early breast cancer, highlighting how adjuvant CDK4/6 inhibitors have expanded treatment options beyond endocrine therapy alone. The faculty review the evidence supporting these agents and discuss how clinical trial eligibility criteria from monarchE and NATALEE inform treatment selection in routine practice. Particular attention is given to assessing recurrence risk using factors such as nodal involvement, tumor size, grade, and other clinicopathologic features while recognizing that many patients do not fit neatly within trial-defined populations. The conversation also addresses the challenges clinicians face when applying study criteria to real-world cases and emphasizes the importance of individualized decision-making. Practical considerations surrounding node-positive and selected node-negative disease are explored as the panel discusses how recurrence risk ultimately guides recommendations for adjuvant CDK4/6 inhibitor therapy.

2 experts are featured in this series

EP. 2: Optimizing Timing of Adjuvant CDK4/6 Inhibitor Initiation in Clinical Practice

ByRuta Rao, MD ,Eric Winer, MD

This segment focuses on the practical considerations surrounding the initiation of adjuvant CDK4/6 inhibitor therapy after surgery and other planned treatments. The faculty discuss how chemotherapy, radiation therapy, endocrine therapy, and ovarian suppression influence treatment sequencing and timing in everyday practice. They review the timing windows established in the monarchE and NATALEE clinical trials and consider how these data can be applied when patients experience delays or require individualized treatment schedules. The conversation also highlights the importance of patient education before treatment begins, ensuring that patients understand the overall treatment plan and expectations for long-term therapy. Looking ahead, the panel examines ongoing research evaluating chemotherapy de-escalation and the potential role of genomic risk assessment in guiding treatment decisions. The discussion concludes with consideration of how treatment sequencing may affect patient adherence and persistence with adjuvant therapy over time.