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monarchE Abemaciclib — SCE Medical Oncology MCQ

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HardBreast CancermonarchE AbemaciclibSCE Medical Oncology

A postmenopausal patient has completely resected ER-positive, HER2-negative early breast cancer with four involved axillary nodes and has completed indicated chemotherapy. Which statement best reflects current NHS use of adjuvant abemaciclib with endocrine therapy?

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Correct answer: B — Four positive nodes meet the high-risk criterion without an additional Ki-67 requirement

Four or more positive axillary nodes satisfy the high-risk nodal route for adjuvant abemaciclib, with no additional Ki-67 threshold. Three positive nodes meet the high-risk criterion when Ki-67 reaches twenty percent: three nodes require additional high-risk pathological features rather than Ki-67 alone under the current criterion. Four positive nodes meet the high-risk criterion when Ki-67 reaches twenty percent: the four-node route does not add a Ki-67 requirement. Four positive nodes meet the high-risk criterion when HER2 amplification is present: abemaciclib is for HR-positive HER2-negative disease. Four positive nodes meet the high-risk criterion when endocrine therapy is omitted: abemaciclib is added to, not substituted for, endocrine therapy.

Reference: NICE TA810 abemaciclib with endocrine therapy for high-risk node-positive early breast cancer (Published July 2022; current NICE TA): https://www.nice.org.uk/guidance/ta810/chapter/1-Recommendations