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What is the preferred sequence of systemic therapy in a patient with endocrine resistant HR+ metastatic breast cancer?

The patient previously received endocrine therapy alone and in combination with CDK 4/6 inhibitor. She does not have any targetable mutations on NGS. What factors would impact your treatment decision?
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For patients without targetable mutations what do you most factor in to your decisions on next line systemic treatment for endocrine resistant, HR+ metastatic breast cancer?

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3 Answers
Mednet Member
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Medical Oncology · Baylor College of Medicine/Dan L Duncan Cancer Center
Answered on

Several factors can affect the next line of therapy in my view like disease free interval (DFI) before the patient developed metastatic disease, duration of response (if any) to prior endocrine with/without CDK4/6i, disease burden, patient's performance status and competing comorbidity.

If the patie...

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Mednet Member
Mednet Member
Medical Oncology · Levine Cancer Institute, Atrium Health
Answered on

This question is in hot debate. We have seen a flurry of drug approvals in the second/third/fourth line space including targeted agents based on the presence of a specific biomarker, next-generation selective estrogen receptor degraders (SERDs), and antibody-drug conjugates (ADCs). I agree with the ...

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Mednet Member
Mednet Member
Medical Oncology · Harvard Medical School
Answered on

The therapeutic approach to endocrine-resistant HR+ metastatic breast cancer is rapidly evolving. The current standard of care typically incorporates an aromatase inhibitor with a CDK4/6 inhibitor in the first-line metastatic setting, and clinicians have been increasingly utilizing ribociclib due to...

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