Yakup Ergün, Medical Oncologist at Bower Hospital, shared on X:
“New ASCO Living Guideline: Stage I–III HR+/HER2− Breast Cancer.
The most notable change in ASCO’s new guideline for early HR+/HER2− breast cancer is that it links treatment decisions to thresholds for the 10-year risk of breast cancer death:
- OFS + AI: recommend if >10%
- CDK4/6i: recommend if >25%, consider if 10–25%, generally do not offer if <10%
- Olaparib: the same >25% / 10–25% / <10% framework
- Anthracycline: favor if >25%, consider if 20–25%, generally avoid if <20%
Moving toward absolute benefit is appropriate; however, these are not predictive cutoffs derived from randomized trials, but pragmatic thresholds set by the panel.
In my view, this provides a more practical framework for clinical decision-making than previous recommendations.
However, the guideline does not specify which model should generate the 10-year risk estimate, and it remains unclear whether existing prognostic tools are adequately calibrated in contemporary patients receiving standard therapy or validated for applying these specific thresholds to CDK4/6 inhibitor and olaparib decisions.”
Title: Medical Therapy for Hormone Receptor-Positive, HER2-Negative Stage I-III Breast Cancer: ASCO Living Guideline, Version 2026.1.0
Authors: Jennifer L. Caswell-Jin, Mark R. Somerfield, Muhammad Ali Khan, Gretchen G. Kimmick, Shilpi Gupta, Kara Kenan, Namrata Peswani, Dawn L. Hershman, Brenda J. Ernst, Brittany E. Harvey, Gregor Krings, Nicholas P. McAndrew, Irbaz Bin Riaz, Ines Vaz-Luis, Cynthia Villarreal-Garza, Japneet Kaur Oberoi, Muhammad Hussnain Sadiq, Huan He, Ramaa Chitale, Michael J. Hassett
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