In September 2024, based on the results of the NATALEE trial, ribociclib was approved for patients with any lymph node involvement (excluding microscopic nodal involvement), or if there was no nodal involvement, either a tumour size > 5 cm, or tumour size 2 to 5 cm with either Grade 2 (and high genomic risk or Ki67 ≥ 20%) or Grade 3. Here, MKI67 is linked to neoplasm.