Is there any benefit of anastrozole in addition to fulvestrant and palbociclib in a patient with HR+ metastatic breast cancer?

When, if ever, would you start AI with fulvestrant and CDK4/6i in a patient with HR+ metastatic breast cancer?

• Always
• Never, I always start with fulvestrant + CDK4/6i without AI
• Never, I always start with AI + CDK4/6i without fulvestrant
• Only in PIK3CA disease
• Only in certain other subsets (please specify)
• I’m waiting on further studies before considering combination use
• Other