Ribociclib with endocrine therapy for adjuvant treatment of hormone receptor-positive HER2-negative early breast cancer [ID6153]

Breast cancer arises from the tissues of the ducts or lobules of the breast.

Breast cancer is described as ‘early’ if it is restricted to the breast or the breast and nearby lymph nodes and has not spread to other parts of the body.

In 2020 there were 39730 new diagnoses of breast cancer in England.(1) Of these 28229 (71%) were diagnoses of early breast cancer.(1) Around two-thirds of breast cancers are hormone receptor-positive and human epidermal growth factor receptor 2 (HER2) negative.(2)(3) Around 5% to 10% of breast cancers have mutations in the BRCA1 or BRCA2 genes.(4)Treatment may depend on genetic mutations receptor status the extent of the disease and previous treatments.

Adjuvant therapy is used to reduce the risk of the cancer coming back after surgery.

The decision about whether to have adjuvant therapy is based on the assessment of the risk of the cancer coming back and the potential benefits and side effects of the treatment.

NICE guideline 101 recommends adjuvant endocrine therapy (tamoxifen or aromatase inhibitors) for hormone receptorpositive early breast cancer.

It also recommends considering ovarian function suppression for premenopausal women and extended endocrine therapy (total duration of endocrine therapy of more than 5-years).

Adjuvant chemotherapy (a regimen containing both a taxane and an anthracycline) adjuvant radiotherapy and adjuvant bisphosphonate therapy (for postmenopausal women) are also recommended for early breast cancer.

NICE technology appraisal 810 recommends abemaciclib with endocrine therapy within its marketing authorisation as an option for adjuvant treatment of hormone receptor-positive HER2-negative node-positive early breast cancer in adults whose disease is at high risk of recurrence.

NICE technology appraisal 886 recommends olaparib (alone or with endocrine therapy) within its marketing authorisation as an option for the adjuvant treatment of HER2-negative high-risk early breast cancer that has been treated with neoadjuvant or adjuvant chemotherapy in adults with germline BRCA1 or 2 mutations.

References1. NHS digital. Case-mix adjusted percentage of cancers diagnosed at stages 1 and 2 in England 2020. Accessed July 2023. 2. DeKoven M Bonthapally V Jiao X et al.

Treatment pattern by hormone receptors and HER2 status in patients with metastatic breast cancer in the UK Germany France Spain and Italy (EU-5): results from a physician survey. J Comp Eff Res 2012;1:45363. 3. Howlader N Altekruse SF Li CI et al. US Incidence of Breast Cancer Subtypes Defined by Joint Hormone Receptor and HER2 Status.

JNCI: Journal of the National Cancer Institute 2014;106. 4. NHS England. Clinical Commissioning Policy: Genetic Testing for BRCA1 and BRCA2 Mutations. Accessed July 2023.