I can only tell you my experience.
I took Ribociclib for 19 days in April at 600mg and 9 days in May at 200mg. I took Letrozole from February 1-June 15. There was no progression. I had clear scans May 31 and Sept 19. I’m not taking any medications now. From mid January on I have been taking 8 mushroom supplements including a high dose of Turkey Tail.

I do not have a clear cut answer.

My 3 cycles were as follows:
Cycle 1 & 2
600mg 3weeks/2 weeks off (to recover from low WBC)

Cycle 3
400mg 3 weeks/1 week off.

There are 3 opinions for the coming two cycles:
A)
Continue with 400mg + Femara
3weeks/1 off

B)
Continue with 600mg + Femara 3 weeks/1 off with close monitoring of WBC

C)
Continue with
400mg + replace Femara/letrozole with fulvestrant/faslodex

The subject of PIC3CA came up. As well as BRCA.

Here's the real problem.

I live in Beirut, Lebanon. Alot of those treatments are not available and when they are they would last for a couple of months and disappear again. They cost alot of money and Private insurance does not cover it and there seem to be no government subsidies.

There's another challenge too with the PIC3CA and BRCA. The sample biopsies have to be sent to the US for testing and analysis and the process would take 3 to 4 weeks and it would cost an arm and a leg.

So even if there is a consensus on which route to take, I am not sure if I will have acess to the treatments.

Looks bleak we try to move forward, be positive and try to keep my 3 kids out of the loop.