The first 60 days: HR-positive / HER2-negative breast cancer

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

• Screening and diagnosisNCCN category Breast Cancer Screening

  Mammography ± tomosynthesis; supplemental MRI for dense breasts or high risk; core biopsy with ER/PR/HER2/Ki-67; AI-assisted reading being deployed.

  Mammography & tomosynthesisAI in radiologyHistopathology & immunohistochemistry

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• PathologistNamed in the standard of care for: Screening and diagnosis, Early stage, deciding on chemotherapy, Metastatic, molecular progression on first line, Metastatic, second line by genotype.
• RadiologistNamed in the standard of care for: Screening and diagnosis.
• Medical oncologistNamed in the standard of care for: Early stage, deciding on chemotherapy, Early stage, adjuvant endocrine therapy, Early stage, high risk: adjuvant CDK4/6, Early stage, extended and adjuvant SERD (emerging) and 6 more.
• Palliative and supportive care teamNamed in the standard of care for: Metastatic, chemotherapy and later lines, Bone-predominant disease and survivorship.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.Early stage, deciding on chemotherapyNCCN category 1, NCCN Breast v.2026

   Genomic assay (Oncotype DX RS ≤25 node-negative or postmenopausal 1-3 nodes; MammaPrint low risk) → endocrine therapy alone; premenopausal RS 16-25 or high clinical risk → chemotherapy or OFS-based escalation.

   TAILORxRxPONDER (SWOG S1007)Oncotype DXMammaPrint (70-gene signature)
2. 2.Early stage, adjuvant endocrine therapyNCCN category 1

   Postmenopausal: aromatase inhibitor 5-10 years (or tamoxifen → AI switch). Premenopausal: tamoxifen 5-10 years; add OFS (+ AI or tamoxifen) for higher-risk or chemotherapy-treated women (SOFT/TEXT).

   Letrozole (and other aromatase inhibitors)TamoxifenGoserelin / leuprolide (ovarian function suppression)SOFT & TEXT
3. 3.Early stage, extended and adjuvant SERD (emerging)

   Extended AI to 10 years for higher-risk (MA.17R, NSABP B-42); adjuvant giredestrant positive in lidERA (2025, not yet approved); CAMBRIA (camizestrant) and EMBER-4 (imlunestrant) ongoing.

   lidERACAMBRIA-1 & CAMBRIA-2Giredestrant
4. 4.Early stage, high risk: adjuvant CDK4/6NCCN category 1

   Abemaciclib 2 years for node-positive high-risk (monarchE); ribociclib 3 years for stage II-III including node-negative high-risk (NATALEE). Palbociclib not effective (PALLAS/PENELOPE-B). Olaparib 1 year if gBRCA (OlympiA).

   AbemaciclibRibociclibmonarchENATALEEPALLAS & PENELOPE-BOlaparib
5. 5.Metastatic, first lineNCCN category 1, preferred, ESMO-MCBS 4 (ribociclib, OS)

   CDK4/6 inhibitor + aromatase inhibitor (or fulvestrant): ribociclib or abemaciclib preferred where OS data are valued; palbociclib acceptable. Premenopausal: add OFS. For relapse on/within 12 months of adjuvant ET with PIK3CA mutation: inavolisib + palbociclib + fulvestrant (INAVO120).

   MONALEESA-2MONARCH 3PALOMA-2INAVO120RibociclibAbemaciclibPalbociclibInavolisib
6. 6.Metastatic, molecular progression on first lineNCCN category Pending inclusion (approval Sep 2026)

   Serial ctDNA; on emergent ESR1 mutation before radiographic progression, switch AI → camizestrant and continue the CDK4/6 inhibitor (SERENA-6; accelerated approval 4 Sep 2026).

   SERENA-6Camizestrant
7. 7.Metastatic, second line by genotypeNCCN category 1 / 2A by agent

   ESR1-mutant: elacestrant, imlunestrant (± abemaciclib), or vepdegestrant. PIK3CA/AKT1/PTEN: capivasertib + fulvestrant; alpelisib + fulvestrant. Any genotype after CDK4/6: gedatolisib + palbociclib + fulvestrant (PIK3CA-wild-type, 2026); everolimus + exemestane or giredestrant (filed); abemaciclib switch (postMONARCH, modest).

   EMBER-3EMERALDVERITAC-2CAPItello-291SOLAR-1GedatolisibevERApostMONARCHElacestrantImlunestrantVepdegestrantCapivasertib
8. 8.Metastatic, endocrine-resistant: ADC before chemotherapyNCCN category 1 (T-DXd HER2-low), ESMO-MCBS 4 (DESTINY-Breast04)

   HER2-low or ultralow (~60%): T-DXd (DESTINY-Breast06 chemotherapy-naive; DESTINY-Breast04 after chemotherapy). HER2-zero: sacituzumab govitecan or Dato-DXd after chemotherapy (TROPiCS-02, TROPION-Breast01).

   DESTINY-Breast06DESTINY-Breast04TROPiCS-02TROPION-Breast01Trastuzumab deruxtecanSacituzumab govitecanDatopotamab deruxtecan
9. 9.Metastatic, chemotherapy and later lines

   Sequential single-agent chemotherapy (capecitabine, taxanes, eribulin, vinorelbine); olaparib/talazoparib if gBRCA; clinical trials; supportive and palliative care integrated early.

   Paclitaxel / nab-paclitaxelOlaparibTalazoparib
10. 10.Bone-predominant disease and survivorship

    Bisphosphonate or denosumab for bone metastases and AI-induced bone loss; adjuvant bisphosphonates in postmenopausal women; exercise, cardio-oncology, and adherence support.

    Exercise & lifestyle oncologyCardio-oncology

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• A Clinical Study of Neoadjuvant Treatment With TQB2102 for Injection for Human Epidermal Growth Factor Receptor 2 (HER2) Positive Breast CancerPhase 3 · recruiting · NCT07043725A Randomized, Open-label, Multicenter, Parallel-controlled Phase III Clinical Trial to Evaluate the Efficacy and Safety of TQB2102 for Injection Versus TCbHP in Neoadjuvant Treatment of Breast Cancer With Positive HER2 Expression
• A Clinical Study of TQB2102 Versus Docetaxel Plus Trastuzumab and Pertuzumab in the Treatment of HER2 Positive Recurrent or Metastatic Breast CancerPhase 3 · recruiting · NCT07003074A Randomized, Open, Multicenter, Parallel-controlled Phase III Clinical Trial to Evaluate the Efficacy and Safety of TQB2102 for Injection Versus Docetaxel Plus Trastuzumab and Pertuzumab in the Treatment of Human Epidermal Growth Factor Receptor 2 (HER2) Positive Recurrent or Metastatic Breast Cancer
• A Clinical Trial of TQB2102 for Injection in the Treatment of HER2 Low-Expressing Recurrent/Metastatic Breast CancerPhase 3 · active · NCT06561607A Randomized, Open, Parallel-Controlled Phase III Clinical Trial Evaluating the Efficacy and Safety of TQB2102 for Injection Versus Investigator-Selected Chemotherapy in HER2 Low-Expressing Recurrent/Metastatic Breast Cancer
• A Comparative Study of AZD9833 Plus Palbociclib Versus Anastrozole Plus Palbociclib in Patients With ER-Positive HER2 Negative Breast Cancer Who Have Not Received Any Systemic Treatment for Advanced DiseasePhase 3 · active · NCT04711252SERENA-4: A Randomised, Multicentre, Double-Blind, Phase III Study of AZD9833 (an Oral SERD) Plus Palbociclib Versus Anastrozole Plus Palbociclib for the Treatment of Patients With Estrogen Receptor-Positive, HER2-Negative Advanced Breast Cancer Who Have Not Received Any Systemic Treatment for Advanced Disease
• A Phase 3 Study of HRS-8080 Versus Treatment Chosen by Physicians in Locally Advanced and Metastatic Breast CancerPhase 3 · recruiting · NCT07024173A Multicenter, Open-label, Randomized Controlled Phase 3 Study of HRS-8080 Versus Treatment Chosen by Physicians in Locally Advanced and Metastatic Breast Cancer With Disease Progression After Previous Endocrine Therapy

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• HR-positive / HER2-negative breast cancer: the full pageHR-positive breast cancer is the most common breast cancer, driven by oestrogen. It was treated for years with hormone-blocking pills, now joined by CDK4/6 inhibitors, PI3K-pathway drugs, degraders, and ADCs.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment journey: Stage I-II (early)Surgery first, a genomic test to decide whether chemotherapy adds anything, a few weeks of radiotherapy, then five to ten years of endocrine tablets, with a CDK4/6 inhibitor for two or three years if the risk is high.
• Guidelines comparedNCCN, ESMO and NICE side by side for this cancer.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.