Table 2.
Practical implications of the post-chemotherapy non-endocrine adjuvant treatments in HR+/HER2- breast cancer.
| Medication | Target population | Starting dose and duration | Time of initiation | Overall survival benefit with statistical significance | ESMO MCBS | Number needed to treat to avoid one invasive recurrence at 4 years |
|---|---|---|---|---|---|---|
| Abemaciclib [85] | N2–N3 or T3N1 or N1 with grade 3 (in certain areas also N1 and Ki-67 ≥ 20%) | 150 mg twice daily, along with ET for 2 years | After radiotherapy, with up to 12 weeks previous ET | No | A | 20a |
| Ribociclib [86, 138] | Anatomical stage IIA, IIB or stage III | 400 mg once daily, along with ET for 3 years | After radiotherapy, up to 12 months previous ET | No | A | 20 |
| Bisphosphonatesb | Postmenopausal | Optimal duration not knownb | Various approaches, no contraindications with surgery or other adjuvant treatments | Contradictory evidence from the original trials. In a meta-analysis (60), RR 0.82 (95% CI 0.73–0.93) in postmenopausal women | Not available | 42 (in postmenopausal women, at 5 years in meta-analysis (68]) |
| Olaparib [22, 139] | Germline BRCA1/2 carriers After adjuvant chemotherapy: N2–N3 After neoadjuvant chemotherapy: no pCR and CPS+EG score ≥ 3 |
300 mg twice daily for 1 year | After radiotherapy | Yes, HR 0.68 (95% CI 0.47–0.97) | A | 14 |
At 5 years, the number needed to treat with abemaciclib to avoid one invasive recurrence is 13 ITT.
Regarding guideline recommendations for specific bisphosphonates and dosing, please see the text for more detailed instructions. Bisphosphonates are officially approved for treating bone metastases, osteoporosis, and not for prevention of relapse.
CI: confidence interval; CPS + EG: clinical pathological staging-estrogen receptor grading; ET: endocrine therapy; HR: hazard ratio; ESMO MCBS: European Society for Medical Oncology Magnitude of Clinical Benefit Scale; pCR: pathological complete response; RR: risk ratio; HER2: human epidermal growth factor receptor 2.