{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T11:16:06Z","timestamp":1768821366887,"version":"3.49.0"},"reference-count":27,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T00:00:00Z","timestamp":1725408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The monarchE study added the CDK4\/6 inhibitor abemaciclib to the care of women with oestrogen-positive (ER+) breast cancers. Eligibility required meeting monarchE criteria\u2014either &gt;3 positive axillary nodes, or 1\u20133 positive sentinel nodes (SNB+) with tumour size &gt;50 mm or grade 3 cancers. Women were advised to proceed to completion axillary node clearance (cANC) if size\/grade criteria were not fulfilled for &gt;3 positive nodes to be identified. However, cANC is associated with significant morbidity, conflicting with the potential benefits of abemaciclib. We analysed data of 229 consecutive women (2016-2022) with ER+ breast cancer and SNB+ who proceeded to cANC, keeping with contemporary treatment guidelines. We used this cohort to assess numbers that, under national guidance in place currently, would be advised to undergo cANC solely to check eligibility for abemaciclib treatment. Using monarchE criteria, 90 women (39%) would have accessed abemaciclib based on SNB+ and size\/grade, without cANC. In total, 139 women would have been advised to proceed to cANC to check eligibility, with only 15\/139 (11%) having &gt;3 positive nodes after sentinel node biopsy and cANC. The remaining 124 (89%) would have undergone cANC but remained ineligible for abemaciclib. Size, age, grade, and Ki67 did not predict &gt;3 nodes at cANC. Following cANC, a large majority of women with ER+, &lt;50 mm, and grade 1\u20132 tumours remain ineligible for abemaciclib yet are subject to significant morbidity including lifelong lymphoedema risk. The monarchE authors state that 15 women need abemaciclib therapy for 1 to clinically benefit. Thus, in our cohort, 139 women undergoing cANC would lead to one woman benefitting.<\/jats:p>","DOI":"10.3390\/cancers16173072","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T02:25:49Z","timestamp":1725416749000},"page":"3072","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Abemaciclib Therapy Using the MonarchE Criteria Results in Large Numbers of Excess Axillary Node Clearances\u2014Time to Pause and Reflect?"],"prefix":"10.3390","volume":"16","author":[{"given":"Daniel","family":"Ahari","sequence":"first","affiliation":[{"name":"Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Manchester M23 9LT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2943-9370","authenticated-orcid":false,"given":"Mark","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Manchester M23 9LT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisha","family":"Ali","sequence":"additional","affiliation":[{"name":"Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Manchester M23 9LT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0737-098X","authenticated-orcid":false,"given":"Vicky P.","family":"Taxiarchi","sequence":"additional","affiliation":[{"name":"Centre for Women\u2019s Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6827-8090","authenticated-orcid":false,"given":"Rajiv V.","family":"Dave","sequence":"additional","affiliation":[{"name":"Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Manchester M23 9LT, UK"},{"name":"Division of Cancer Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University Foundation Trust, Manchester M13 9PL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7264-6201","authenticated-orcid":false,"given":"Ashu","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Wythenshawe Hospital and Nightingale Breast Cancer Centre, Manchester University Foundation Trust, Manchester M23 9LT, UK"},{"name":"Division of Cancer Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester University Foundation Trust, Manchester M13 9PL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1093\/jnci\/djab186","article-title":"Decreasing incidence of estrogen receptor\u2013negative breast cancer in the United States: Trends by race and region","volume":"114","author":"Chernyavskiy","year":"2022","journal-title":"JNCI J. 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