Ok ...so here is my thinking.
They assume that we won't go on to develop metstatic disease until we have stopped our AIs. So in theory when first diagnosed with mestatic disease is we start the ribociclib and AI.
It certainly seems unfair on women currently on treatment.
I wonder if this new drug inclusion will mean oncologists will choose tamoxifen for women post menopause just in case which is the lesser "best practise" treatment for post menopause women.
Lets hope advancement on availability will come in soon and trials also start on women already diagnosed stage 1V on AI ...as there are plenty of women willing to putting their hand up to have a go.