Importance of Identifying High-Risk Node-Positive Patients in EBC - Video

Given the tumor size and nodal involvement, she was considered high risk. Clinical evidence shows that patients with tumors ≥5 cm or histological grade 3 have a significantly increased risk of recurrence within five years if treated with endocrine therapy alone ^1,2,3. More than 70% of patients present with 1–3 positive nodes, but the risk is not uniform across this group ^2,4. For high-risk patients, five-year invasive disease-free survival decreases from 89% to 74%, representing a 15% absolute difference².

This is where adjuvant abemaciclib comes in. For patients with ≥4 positive nodes, or with 1–3 nodes plus high-risk features, abemaciclib is now recommended in addition to standard endocrine therapy³.

While overall survival data are still maturing, abemaciclib plus endocrine treatment shows a sustained invasive disease free survival benefit beyond a 2-year treatment period reaching 7.9% at 5 years^3,5,6,7,8.

The patient underwent neoadjuvant chemotherapy followed by breast-conserving surgery with axillary resection and radiation therapy. Adjuvant treatment included letrozole for 7–8 years and abemaciclib for the first 2 years. Early grade 2 diarrhea was managed with treatment interruption and loperamide, while ongoing monitoring included blood counts, liver tests, tumor markers, and DEXA scans³. Despite the need for supportive care, she was able to continue treatment successfully, reflecting the feasibility and benefit of adjuvant abemaciclib in high-risk, node-positive early breast cancer. The real world evidence shows that despite the need for dose reductions seen in about half of patients, 93% continued treatment⁹.

Abemaciclib is now a standard of care for HR +, HER2-, node positive, high risk early breast cancer patients. So identifying these patients early and managing treatment effectively can make a long-term difference in outcomes^11,12,13.

1. Sheffield KM et al. Future Oncol. 2022;18(21):2667-82. 2. Tolaney SM et al. Presented at San Antonio Breast Cancer Symposium; San Antonio, Texas; December 10-13, 2024. Poster P1-11-02. 3. Ramiven India Abridged Prescribing Information, Literature revised: 14 July 2023, Version Control No.: PA008SPIN05. 4. Nelson DR et al. PLoS ONE. 2022;17(2):e0264637. 5. Rastogi P et al. J Clin Oncol. 2024;42(9):987-93. 6. Johnston SRD et al. Lancet Oncol. 2023;24(1):77-90. 7. Johnston SRD et al. J Clin Oncol. 2020;38(34):3987-98. 8. Harbeck N et al. Ann Oncol. 2021;32(12):1571-81. 9. Hudson K et al. Presented at San Antonio Breast Cancer Symposium; San Antonio, Texas; December 10-13, 2024. Poster P1-11-29. 10. Goetz MP et al. NPJ Breast Cancer. 2024;10(1):34. 11. Loibl S et al. Ann Oncol. 2024;35(2):159-82. 12. Freedman RA et al. J Clin Oncol. 2024;42(18):2233-5 13. Curigliano G et al. Ann Oncol. 2023;34(11):970-86.