HR+ Early Breast Cancer

Authored by Ilana Schlam, published on 2026-04-12 17:09:45.0

Post ASCO, ESMO and SABCS 2025 HR+ Early Breast Cancer treatment algorithm. Add Zometa for 2-3 years for postmenopausal early-stage disease.*Patients with 4+ Lymph nodes and/or large tumors excluded from RxPONDER /TailorX, consider chemotherapy.**Stage 2A if N1 or NO G3 or NO G2 + Ki67 >20%, high risk genomic score, 2B, 3.

  1. HR+ early stage
    *FOR SELECTED PATIENTS: BRCAwt Abemaciclib - MonarchE (2y, 4+ LN or 1-3 LN + G3 or 5+ cm) Ribociclib – NATALEE (3y, stage 2A if N1 or N0+high risk, 2B, 3**) gBRCAm Olaparib - OlympiA (1y, T2 or 4+ LN)
    • Node negative (connsider CDK4/6 inhibitor in the adjuvant setting for patients with high risk disease per NATALEE)
      TailorX 2018, 2019
      • Surgery
        • Premenopausal
          • RS 1-15
            * lidERA: giradestrant vs ET in stage 1-3 disease
            • Endocrine therapy
          • RS 16-25
            • Some may benefit from chemotherapy
              * lidERA: giradestrant vs ET in stage 1-3 disease
              • Endocrine therapy
          • RS 26+
            • Chemotherapy (TC)
              * lidERA: giradestrant vs ET in stage 1-3 disease
              • Endocrine therapy
        • Postmenopausal
          • RS 1-25
            • Endocrine therapy
          • RS 26+
            • Chemotherapy (TC)
              • Endocrine therapy
    • Positive LN* consider CDK4/6i in the adjuvant setting
      • 1-3 LN
        RxPonder
        • Surgery
          • Premenopausal
            • RS 1-25
              • Chemotherapy vs OFS + AI
                • Endocrine therapy
            • RS 26+
              • Chemotherapy (TC, ddAC-T)
                • Endocrine therapy
          • Postmenopausal
            • RS 1-25
              • Endocrine therapy
            • RS 26+
              • Chemotherapy (TC, ddAC-T)
                • Endocrine therapy
      • 4+ LN*
        • Surgery
          • Chemotherapy (ddAC-T>TC)
            • Endocrine therapy
tosprivacyAbemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2-, Node-Positive, High-Risk, Early Breast Cancer (monarchE)Ribociclib plus Endocrine Therapy in Early Breast CancerAdjuvant Olaparib for Patients with BRCA1- or BRCA2-Mutated Breast CancerAdjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast CancerA Study Evaluating the Efficacy and Safety of Adjuvant Giredestrant Compared With Physician's Choice of Adjuvant Endocrine Monotherapy in Participants With Estrogen Receptor-Positive, HER2-Negative Early Breast Cancer (lidERA Breast Cancer)21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer