The present study cannot address the impact of the MONARCHE trial on use of ALND for staging purposes in patients with cN-positive BC because it was published toward the end of the study period.10 Nodal stage was used for risk stratification, and patients with high-risk early-stage HR-positive disease were randomly assigned to receive endocrine therapy with the CDK4/6 inhibitor abemaciclib or endocrine therapy alone in the adjuvant setting. This evidence concerns the gene CDK4 and breast cancer.