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

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 patient's DFI was short, did not respond well to prior endocrine based therapy, and has a higher disease burden, I would tend to favor chemotherapy like nab-paclitaxel, eribulin, or maybe capecitabine (wit...

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 questioner that next-generation sequencing is crucial to aid in the next treatment decisions, either on tumor tissue or a liquid biopsy. When there are no targeted options available, I think it remain...

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 updated survival data demonstrating clear benefit in MONALEESA-2 (Hortobagyi et al., PMID 35263519).

Following progression on AI/CDK4/6i therapy, the approach in the second line setting has changed dr...