Stephanie Graff, MD, FACP: This is another great case of a premenopausal patient who is at high risk for disease recurrence. One of the interesting and great things that’s happening in breast cancer, if you look across the history of the disease, is that we’re lucky to live in a time when there is an overwhelming number of patients participating in screening in the United States, so most patients [receive] breast cancer [diagnoses] early, but that doesn’t necessarily mean that they do not have biologically aggressive disease. It means that they have screen-detected disease. We also live at a time when our surgical colleagues have been accelerating the pace of surgical research and have advanced surgical research to the place where, more often, our patients are not having axillary lymph node dissections. They’re having sentinel lymph node biopsies alone, or sometimes even omission of sentinel lymph nodes for [older] patients. Many patients with hormone receptor–positive breast cancers have early anatomic stage disease that may not correlate with a biologically low-risk disease. So, one of the nice things about the NATALEE [NCT03701334] trial was that broader eligibility criteria than what was included in monarchE [NCT03155997], which allows us to think about CDK4/6 inhibitors in a slightly wider group of patients.

Transcript edited for clarity.