Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی

Treating hormone receptor-positive breast cancer (HR+/HER2−‎): hormone therapy and CDK4/6 inhibitors

Hormone tablets are the backbone: tamoxifen or an aromatase inhibitor, 5 or 10 years, genomic tests to avoid unnecessary chemotherapy, and abemaciclib, palbociclib and ribociclib after surgery and in disease that has spread

Updated: 28 October 20268 min read37 references
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Key points

  • About 7 in every 10 breast cancers are hormone receptor-positive and HER2-negative; this cancer grows on the female hormone oestrogen [34, 1].
  • The backbone of treatment is hormone tablets for 5 to 10 years: 5 years of tamoxifen cut the risk of dying from breast cancer by about a third over the next 15 years [1], and taking the tablets regularly and to the end really matters [25].
  • Many women do not need chemotherapy: a genomic test on the tumour shows who benefits from it [7, 8].
  • When the risk of relapse is high, abemaciclib tablets with hormone tablets lowered relapse and lengthened life [9].
  • In disease that has spread, the first treatment is usually hormone tablets with a CDK4/6 tablet, which has made the disease stay under control much longer [11, 36].

The story of hormone tablets

Hormone receptor-positive breast cancer needs oestrogen, the female hormone, to grow. Tamoxifen tablets, which block the effect of oestrogen on the cancer cell, have been the backbone of treatment for this type of cancer for decades. A review of all the large studies showed that 5 years of tamoxifen after surgery almost halves relapse in the first 5 years and cuts the risk of dying from breast cancer by about a third over the next 15 years; but it has no effect in tumours without hormone receptors [1].

Then came the "aromatase inhibitors" (letrozole, anastrozole and exemestane), which reduce the making of oestrogen in women after menopause. In women after menopause, these tablets lowered relapse even more than tamoxifen and reduced deaths from breast cancer a little more [2]. In younger women, whose ovaries still make oestrogen, temporarily switching off the ovaries with an injected drug (such as goserelin) together with hormone tablets lowered relapse and lengthened life; the benefit was greater in higher-risk women, such as those who had chemotherapy and still had periods [5].

The next big lesson was that the risk of relapse from this cancer lasts for years: even after 5 years of tablets, the risk of relapse continued at a steady rate for up to 20 years and depended on the size of the tumour and the number of lymph nodes involved [4]. Continuing tamoxifen to 10 years lowered relapse and deaths from breast cancer [3], and today continuing hormone therapy to 10 years is recommended for most women whose lymph nodes were involved [6].

The latest advance was the "CDK4/6 inhibitor" tablets (abemaciclib, palbociclib and ribociclib), which stop the cancer cell from dividing and are given together with hormone tablets. These tablets improved results first in disease that has spread, and then after surgery in high-risk patients [11, 9].

7 in 10
Breast cancers that are hormone receptor-positive and HER2-negative
[34]
A third
Reduction in the risk of dying from breast cancer with 5 years of tamoxifen, over the next 15 years
[1]
20 years
How long the risk of relapse still continues after 5 years of hormone tablets
[4]

After surgery: hormone tablets and the decision about chemotherapy

  1. 1

    Hormone tablets for everyone

    Women after menopause usually take an aromatase inhibitor (such as letrozole) and women before menopause take tamoxifen; in young women at high risk, together with a drug that switches off the ovaries [2, 5]. Treatment lasts 5 to 10 years [6].

  2. 2

    Genomic test on the tumour: is chemotherapy needed?

    A test on the tumour sample (such as the 21-gene test) shows how much chemotherapy would help. In two large studies, women with a low or intermediate score whose lymph nodes were not involved, and women after menopause with 1 to 3 involved nodes, did just as well with hormone tablets alone and gained nothing from chemotherapy [7, 8]. In younger women (aged 50 or under, or before menopause) chemotherapy sometimes helps [7, 8].

  3. 3

    Abemaciclib when the risk of relapse is high

    If several lymph nodes are involved or the tumour is large or aggressive, 2 years of abemaciclib tablets with hormone tablets lowered relapse by about a quarter and lengthened life; this benefit lasted for years after the tablets were stopped [9, 26].

  4. 4

    Ribociclib in a wider group

    3 years of ribociclib tablets with an aromatase inhibitor lowered relapse in patients with stage 2 and 3 disease (sometimes even without lymph node involvement); its effect on survival is not yet certain [10].

If the disease has spread

When the disease has spread, the aim is long-term control with a good life, and many women live with it for years [14]. The first treatment is usually hormone tablets (an aromatase inhibitor) with one of the CDK4/6 tablets, and in women before menopause, together with a drug that switches off the ovaries [11, 36, 15]. Adding these tablets made the disease stay under control much longer [11, 36]. Their effect on survival has not been the same: with abemaciclib, patients typically lived about a year longer, but this difference was not proven for certain [13]; with palbociclib, no clear difference in survival was seen [12]; and ribociclib clearly lengthened life, both in women after menopause and in younger women [14, 15].

If the disease progresses on the first treatment, options are chosen according to earlier treatment and new tests: fulvestrant injections, alone or with a CDK4/6 tablet if you have not had one before [16, 35]; everolimus tablets with exemestane [17]; olaparib tablets for an inherited BRCA mutation [24]; and if the tumour is "HER2-low", trastuzumab deruxtecan [23]. Chemotherapy also has its place at some stage of treatment [23].

New tests on blood or tumour: when the disease progresses, testing for an ESR1 mutation is recommended, preferably on blood [19]. Testing for PIK3CA also matters; about 4 in every 10 patients have this mutation [20]. These mutations open the way to newer drugs: new anti-hormone tablets (such as elacestrant, imlunestrant and camizestrant) for an ESR1 mutation [18, 27, 28], and drugs such as alpelisib, capivasertib and inavolisib for changes in the PIK3CA pathway [20, 21, 22].

Why does taking hormone tablets regularly matter so much?

Hormone tablets only work when they are taken every day until the end of the course. In a study of more than 8,000 women, about 3 in every 10 stopped the tablets early, and women who stopped early or took them irregularly were less likely to be alive in the following years [25].

Common side effects are hot flushes and joint and muscle pain [37]. Tamoxifen slightly raises the risk of blood clots and womb cancer, and aromatase inhibitors weaken the bones and slightly increase fractures [3, 2]. Most of these side effects can be managed; do not stop the tablets yourself, and talk to your doctor.

Ask this before treatment starts
  • "Would a genomic test on my tumour help decide about chemotherapy?" [7, 8]
  • "Should I take hormone tablets for 5 years or 10 years?" [6]
  • "Is my risk of relapse high enough to need a CDK4/6 tablet as well?" [9, 10]

When should I call my doctor?

With tamoxifen: report swelling or pain in one calf, unexplained breathlessness, abnormal vaginal bleeding or pelvic pain, and changes in vision early [33]. With CDK4/6 tablets: report fever, chills or signs of infection, and a new cough or breathlessness straight away [31, 32]. With abemaciclib, at the first loose stool take the anti-diarrhoea medicine your doctor gave you, drink more fluids and tell your doctor straight away [30]. Ribociclib needs a heart tracing (ECG) before starting and in the first weeks; report a racing or irregular heartbeat, dizziness or feeling faint straight away [31].

Frequently asked questions

Should I take hormone tablets for 5 years or 10 years?

It depends on the risk of relapse. The risk of relapse lasts up to 20 years after diagnosis and depends on the size of the tumour and the number of nodes involved [4]. Continuing to 10 years is recommended for most women whose lymph nodes were involved; when the risk is lower, the decision is made in discussion with your doctor, taking side effects into account [6].

Do all women with hormone receptor-positive breast cancer need chemotherapy?

No. In two large studies, many women with a low or intermediate risk on a genomic test of the tumour gained nothing from chemotherapy [7, 8].

Can I get pregnant while on hormone tablets?

In a study of women aged 42 or under who temporarily stopped hormone tablets after 18 to 30 months to try for a pregnancy, the risk of relapse did not increase, at least in the first 3 years, and about 3 in every 4 women became pregnant [29]. Always make this decision with your doctor; see Fertility and sex during cancer treatment.

If the disease has spread, how long can one live with this treatment?

In many women this disease is controlled for years. In a large study, half of the women who had hormone tablets with ribociclib as their first treatment lived more than 5 years [14]. Every patient is different; ask your doctor about your own situation.

Are the CDK4/6 tablets different from one another?

All three have made the disease stay under control longer, but their side effects and the care they need differ a little: the common side effect of abemaciclib is diarrhoea [30], palbociclib often lowers white blood cells [32], and ribociclib needs heart tracings (ECG) and liver tests [31]. In disease that has spread, ribociclib has shown the clearest gain in survival [14, 15]. Your doctor chooses one based on your situation.

For physicians

Show detailsHide
For physicians
First line in advanced disease: aromatase inhibitor with a CDK4/6 inhibitor
TrialPopulation and interventionProgression-free survivalOverall survival
PALOMA-2 [11, 12]Postmenopausal, 666 patients; palbociclib + letrozoleMedian 24.8 versus 14.5 months; HR 0.58Median 53.9 versus 51.2 months; HR 0.96; not significant
MONARCH 3 [36, 13]Postmenopausal, 493 patients; abemaciclib + nonsteroidal aromatase inhibitorHR 0.54 (median not reached with abemaciclib at the first analysis; placebo 14.7 months)Median 66.8 versus 53.7 months; HR 0.804; P=0.0664, not significant (follow-up 8.1 years)
MONALEESA-2 [14]Postmenopausal, 668 patients; ribociclib + letrozoleNot given in this reportMedian 63.9 versus 51.4 months; HR 0.76; P=0.008
MONALEESA-7 [15]Pre-‎ or perimenopausal, 672 patients; ribociclib + goserelin + nonsteroidal aromatase inhibitor or tamoxifenNot given in this report42-month OS 70.2% versus 46.0%; HR 0.71

PALOMA-2: an imbalance in patients with unknown survival status (13.3% versus 21.2%) limited interpretation of OS [12].

For physicians

Adjuvant endocrine therapy: EBCTCG 2011 (20 trials, 21,457 patients): 5 years of tamoxifen in ER-positive disease, RR for recurrence 0.53 in years 0 to 4 and 0.68 in years 5 to 9; RR for breast cancer death 0.71, 0.66 and 0.68 in years 0 to 4, 5 to 9 and 10 to 14; little or no effect in ER-negative disease [1]. EBCTCG 2015 (31,920 postmenopausal women): aromatase inhibitor versus tamoxifen, RR for recurrence 0.70 during the periods when treatments differed; 10-year breast cancer mortality 12.1% versus 14.2% (5 years of AI versus 5 years of tamoxifen); 10-year endometrial cancer 0.4% versus 1.2% and 5-year fracture risk 8.2% versus 5.5% [2]. ATLAS (6846 women with ER-positive disease): 10 versus 5 years of tamoxifen, recurrence during years 5 to 14 21.4% versus 25.1% and breast cancer mortality 12.2% versus 15.0%; pulmonary embolism RR 1.87 and endometrial cancer RR 1.74 [3]. EBCTCG 2017 (62,923 women): risk of distant recurrence in years 5 to 20 after 5 years of endocrine therapy ranged from 13% (T1N0) to 41% (T2N4–9) [4]. ASCO 2019: extended therapy including an AI up to a total of 10 years for node-positive disease, and for many node-negative patients based on risk; modest absolute benefit and no OS advantage [6]. SOFT/TEXT: 8-year DFS in SOFT 78.9% (tamoxifen), 83.2% (tamoxifen + OFS) and 85.9% (exemestane + OFS); 8-year OS 91.5%, 93.3% and 92.1%; in HER2-negative patients who received chemotherapy, distant recurrence with exemestane + OFS 7.0 (SOFT) and 5.0 (TEXT) percentage points lower than with tamoxifen + OFS; grade ≥3 adverse events 24.6%, 31.0% and 32.3% [5].

Genomic testing: TAILORx (N0, RS 11 to 25; 6711 randomised patients): endocrine therapy alone non-inferior (HR for iDFS 1.08); 9-year iDFS 83.3% versus 84.3% and OS 93.9% versus 93.8%; some chemotherapy benefit at age 50 or younger with RS 16 to 25 [7]. RxPONDER (1 to 3 positive nodes, RS ≤25; 5083 women): postmenopausal 5-year iDFS 91.9% versus 91.3% (HR 1.02); premenopausal 89.0% versus 93.9% (HR 0.60) [8]. ESMO Pan-Asian 2024: gene expression assays when the indication for adjuvant chemotherapy is uncertain [I, B]; 2 years of abemaciclib in stage III or high-risk stage II disease [I, A] [26].

Adjuvant CDK4/6 inhibitors: monarchE (5637 patients, high-risk node-positive): 7-year iDFS 77.4% versus 70.9% (HR 0.734); OS HR 0.842 (P=0.027; 7-year 86.8% versus 85.0%) [9]. NATALEE (stage II–III including high-risk N0; ribociclib for 3 years + NSAI): iDFS HR 0.716 with a 5-year absolute difference of 4.5%; OS HR 0.800 (95% CI 0.637 to 1.003), still immature [10]. Doses: adjuvant endocrine therapy · abemaciclib (monarchE) · ribociclib (NATALEE).

Later lines in advanced disease: PALOMA-3: fulvestrant + palbociclib, median PFS 9.2 versus 3.8 months (HR 0.42) [16]; MONARCH 2: fulvestrant + abemaciclib 16.4 versus 9.3 months (HR 0.553) [35]. BOLERO-2: exemestane + everolimus 6.9 versus 2.8 months (HR 0.43) [17]. OlympiAD in gBRCA carriers [24]. DESTINY-Breast06 (HER2-low after endocrine therapy and before chemotherapy): PFS 13.2 versus 8.1 months (HR 0.62) [23]. ASCO 2023: routine testing for emergent ESR1 mutations at recurrence or progression on endocrine therapy (± CDK4/6i), on blood or tissue obtained at progression, with ctDNA preferred [19]. EMERALD (elacestrant after a CDK4/6i; ESR1 mutation in 47.8%): HR for PFS 0.70 overall and 0.55 with an ESR1 mutation [18]. EMBER-3: imlunestrant with an ESR1 mutation, median PFS 5.5 versus 3.8 months; imlunestrant + abemaciclib versus imlunestrant 9.4 versus 5.5 months (HR 0.57) [27]. SERENA-6 (switch to camizestrant on emergence of ESR1 in ctDNA during first line, before progression): PFS 16.0 versus 9.2 months (HR 0.44) [28]. PIK3CA pathway: SOLAR-1 (alpelisib + fulvestrant, PIK3CA mutation): 11.0 versus 5.7 months (HR 0.65); hyperglycaemia the most common grade 3 or 4 adverse event [20]. CAPItello-291 (capivasertib + fulvestrant): overall population 7.2 versus 3.6 months (HR 0.60) and AKT pathway alterations 7.3 versus 3.1 months (HR 0.50) [21]. INAVO120 (inavolisib + palbociclib + fulvestrant for a PIK3CA mutation with relapse during or within 12 months of adjuvant therapy): 15.0 versus 7.3 months (HR 0.43) [22]. Doses: endocrine therapy + CDK4/6 inhibitor · exemestane + everolimus · inavolisib (INAVO120).

Safety: ribociclib: ECG before starting, start only with QTcF below 450 ms, repeat at about day 14 of cycle 1 [31]. Palbociclib: CBC before starting, at the start of each cycle and on day 15 of the first 2 cycles [32]. Abemaciclib: at the first loose stool, antidiarrhoeal medicine and more fluids [30]. ILD/pneumonitis has been reported with all three drugs [30, 31, 32].

Scientific evidence

Show detailsHide

Scientific evidence

21 items
Meta-analysis

Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

The Lancet · 2011
RR 0.53 (SE 0.03)Recurrence rate ratio in ER-positive disease, years 0 to 4
Summary
Meta-analysis

Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials

The Lancet · 2015
RR 0.64Comparison 1: recurrence in years 0 to 1 (5 years of an aromatase inhibitor vs 5 years of tamoxifen)
Summary
Clinical trial

Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial

The Lancet · 2013
617 recurrences among 3428 women vs 711 recurrences among 3418 womenBreast cancer recurrence (ER positive)
Summary
Meta-analysis

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

N Engl J Med · 2017
13%Risk of distant recurrence, T1N0
Summary
Clinical trial · Phase 3

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer

N Engl J Med · 2018
HR 1.08iDFS (endocrine therapy vs chemo + endocrine)
Summary
Clinical trial · Phase 3

Overall survival with abemaciclib in early breast cancer

Ann Oncol · 2026
0.842 (95% CI 0.722–0.981)Overall survival (HR)
Summary
Clinical guideline

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancer

ESMO Open · 2024
Summary
Clinical trial · Phase 3

Palbociclib and Letrozole in Advanced Breast Cancer

N Engl J Med · 2016
24.8 months vs 14.5 monthsMedian PFS (median progression-free survival)
Summary
Clinical trial · Phase 3

MONARCH 3: Abemaciclib As Initial Therapy for Advanced Breast Cancer

JCO · 2017
HR 0.54 (95% CI 0.41–0.72)Progression-free survival (PFS)
Summary
Clinical trial · Phase 3

MONARCH 2: Abemaciclib in Combination With Fulvestrant in Women With HR+/HER2−‎ Advanced Breast Cancer Who Had Progressed While Receiving Endocrine Therapy

JCO · 2017
16.4 vs 9.3 monthsMedian PFS
Summary
Clinical trial · Phase 3

Everolimus in Postmenopausal Hormone-Receptor–Positive Advanced Breast Cancer

N Engl J Med · 2012
6.9 months vs 2.8 monthsMedian progression-free survival (local investigator assessment)
Summary
Clinical trial · Phase 3

Trastuzumab Deruxtecan after Endocrine Therapy in Metastatic Breast Cancer

N Engl J Med · 2024
13.2 vs 8.1 monthsProgression-free survival (HER2-low)
Summary
Clinical trial · Phase 3

Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation

N Engl J Med · 2017
7.0 months vs 4.2 months (olaparib vs standard therapy)Median PFS (median progression-free survival)
Summary
Clinical trial

Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer

N Engl J Med · 2023
368 women (74.0%)Women with at least one pregnancy (of 497 women followed for pregnancy status)
Summary
Clinical trial · Phase 3

Adjuvant ribociclib plus nonsteroidal aromatase inhibitor therapy in patients with HR-positive/HER2-negative early breast cancer: 5-year follow-up of NATALEE efficacy outcomes and updated overall survival

ESMO Open · 2025
0.716 (95% CI 0.618–0.829)Invasive disease-free survival (HR)
Summary
Clinical trial · Phase 3

Overall Survival with Ribociclib plus Letrozole in Advanced Breast Cancer

N Engl J Med · 2022
6.6 yearsMedian follow-up
Summary
Clinical trial · Phase 3

Overall Survival with Ribociclib plus Endocrine Therapy in Breast Cancer

N Engl J Med · 2019
83 of 335 patients (24.8%) vs 109 of 337 patients (32.3%)Deaths
Summary
Clinical trial · Phase 3

Inavolisib-Based Therapy in PIK3CA -Mutated Advanced Breast Cancer

N Engl J Med · 2024
15.0 months vs 7.3 months (inavolisib group vs placebo group)Median progression-free survival
Summary
Clinical trial · Phase 3

First-Line Camizestrant for Emerging ESR1-Mutated Advanced Breast Cancer

N Engl J Med · 2025
16.0 vs 9.2 monthsMedian progression-free survival
Summary
Clinical trial · Phase 3

Imlunestrant with or without Abemaciclib in Advanced Breast Cancer

N Engl J Med · 2025
5.5 months vs 3.8 monthsMedian PFS — patients with ESR1 mutations (imlunestrant vs standard therapy)
Summary
Clinical trial · Phase 3

Palbociclib in Hormone-Receptor–Positive Advanced Breast Cancer

N Engl J Med · 2015
9.2 monthsMedian PFS — palbociclib + fulvestrant
Summary

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References

37 references
Show all references, 22 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

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    Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trialsEarly Breast Cancer Trialists' Collaborative Group (EBCTCG), Davies C, Godwin J, Gray R, Clarke M, Cutter D, et al · Lancet · 2011;378:771-784
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    Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trialsEarly Breast Cancer Trialists' Collaborative Group (EBCTCG) · Lancet · 2015;386:1341-1352
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  3. 3
    Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trialDavies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al · Lancet · 2013;381:805-816
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    20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 YearsPan H, Gray R, Braybrooke J, Davies C, Taylor C, McGale P, et al · N Engl J Med · 2017;377:1836-1846
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    Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast CancerFrancis PA, Pagani O, Fleming GF, et al · N Engl J Med · 2018;379:122-137
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    Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: ASCO Clinical Practice Guideline Focused UpdateBurstein HJ, Lacchetti C, Anderson H, et al · J Clin Oncol · 2019;37:423-438
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    Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast CancerSparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, et al · N Engl J Med · 2018;379:111-121
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    Overall survival with abemaciclib in early breast cancerJohnston S, Martin M, O'Shaughnessy J, Hegg R, Tolaney SM, Guarneri V, et al · Ann Oncol · 2026;37:155-165
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    Adjuvant ribociclib plus nonsteroidal aromatase inhibitor therapy in patients with HR-positive/HER2-negative early breast cancer: 5-year follow-up of NATALEE efficacy outcomes and updated overall survivalCrown J, Stroyakovskii D, Yardley DA, Huang CS, Fasching PA, Bardia A, et al · ESMO Open · 2025;10:105858
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    Palbociclib and Letrozole in Advanced Breast CancerFinn RS, Martin M, Rugo HS, Jones S, Im SA, Gelmon K, et al · N Engl J Med · 2016;375:1925-1936
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    Overall Survival With Palbociclib Plus Letrozole in Advanced Breast CancerSlamon DJ, Diéras V, Rugo HS, et al · J Clin Oncol · 2024;42:994-1000
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  13. 13
    Abemaciclib plus a nonsteroidal aromatase inhibitor as initial therapy for HR+, HER2- advanced breast cancer: final overall survival results of MONARCH 3Goetz MP, Toi M, Huober J, et al · Ann Oncol · 2024;35:718-727
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    Overall Survival with Ribociclib plus Letrozole in Advanced Breast CancerHortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Hart L, et al · N Engl J Med · 2022;386:942-950
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    Overall Survival with Ribociclib plus Endocrine Therapy in Breast CancerIm SA, Lu YS, Bardia A, Harbeck N, Colleoni M, Franke F, et al · N Engl J Med · 2019;381:307-316
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    Palbociclib in Hormone-Receptor–Positive Advanced Breast CancerTurner NC, Ro J, André F, Loi S, Verma S, Iwata H, et al · N Engl J Med · 2015;373:209-219
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  17. 17
    Everolimus in postmenopausal hormone-receptor-positive advanced breast cancerBaselga J, Campone M, Piccart M, et al · N Engl J Med · 2012;366:520-9
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  18. 18
    Elacestrant (oral selective estrogen receptor degrader) Versus Standard Endocrine Therapy for Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer: Results From the Randomized Phase III EMERALD TrialBidard FC, Kaklamani VG, Neven P, et al · J Clin Oncol · 2022;40:3246-3256
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    Testing for ESR1 Mutations to Guide Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer: ASCO Guideline Rapid Recommendation UpdateBurstein HJ, DeMichele A, Somerfield MR, et al · J Clin Oncol · 2023;41:3423-3425
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    Alpelisib for PIK3CA-Mutated, Hormone Receptor-Positive Advanced Breast CancerAndré F, Ciruelos E, Rubovszky G, et al · N Engl J Med · 2019;380:1929-1940
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    Capivasertib in Hormone Receptor-Positive Advanced Breast CancerTurner NC, Oliveira M, Howell SJ, et al · N Engl J Med · 2023;388:2058-2070
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    Inavolisib-Based Therapy in PIK3CA-Mutated Advanced Breast CancerTurner NC, Im SA, Saura C, Juric D, Loibl S, Kalinsky K, et al · N Engl J Med · 2024;391:1584-1596
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    Trastuzumab Deruxtecan after Endocrine Therapy in Metastatic Breast CancerBardia A, Hu X, Dent R, et al · N Engl J Med · 2024;391:2110-2122
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    Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA MutationRobson M, Im SA, Senkus E, Xu B, Domchek SM, Masuda N, et al · N Engl J Med · 2017;377:523-533
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    Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with early breast cancerPark KH, Loibl S, Sohn J, Park YH, Jiang Z, Tadjoedin H, et al · ESMO Open · 2024;9:102974
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    Imlunestrant with or without Abemaciclib in Advanced Breast CancerJhaveri KL, Neven P, Casalnuovo ML, et al · N Engl J Med · 2025;392:1189-1202
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    Interrupting Endocrine Therapy to Attempt Pregnancy after Breast CancerPartridge AH, Niman SM, Ruggeri M, et al · N Engl J Med · 2023;388:1645-1656
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