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In 2022, in response to updated data from the monarchE clinical trial of adjuvant abemaciclib for node-positive, high-risk, hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative breast cancer, ASCO published a rapid recommendation update addressing the use of adjuvant abemaciclib and a companion report addressing questions that clinicians may face in implementation. Subsequently, in 2024, a preplanned follow-up report from monarchE demonstrated a deepening benefit of adjuvant abemaciclib over endocrine therapy (ET) alone, with an absolute improvement in invasive disease-free survival (IDFS) of 7.6% at 5 years as compared with 4.8% at 3 years and a hazard ratio (HR) for IDFS of 0.68 (95% CI 0.60-0.77).

Also in 2024, the first preplanned analysis of the NATALEE clinical trial of adjuvant ribociclib for stage II to III hormone receptor–positive, HER2-negative breast cancer was published, demonstrating a 3.3% absolute improvement of ribociclib over ET alone for IDFS at 3 years, with a HR of 0.75 (95% CI 0.62-0.91).

In response to the 2024 data updates, ASCO published a second rapid recommendation update of the guideline on the selection of optimal adjuvant chemotherapy and targeted therapy for early breast cancer. The rapid update addressed the use of adjuvant cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, abemaciclib and ribociclib, in patients with stage II and III breast cancer.

This companion Guideline Clinical Insights article considers some of the questions that clinicians may face as they implement the updated recommendations in clinical practice.

Read an interview about the companion article here and expert commentary about it here.