What would be your next line of therapy for a postmenopausal metastatic ER+/Her 2- BC, s/p anastrazole and palbociclib/fulvestrant who has progressive disease and ESR1 mutation on ctDNA?

For this postmenopausal metastatic ER+/HER2-negative breast cancer patient, progressing after anastrozole and palbociclib/fulvestrant with an ESR1 mutation, elacestrant, imlunestrant, or vepdegestrant monotherapy are all appropriate ESR1-directed options. Elacestrant has the longest track record and...

Given FDA approval of imlunestrant and vepdegestrant for patients with ESR1 mutation positive, hormone receptor positive, HER2 negative metastatic breast cancer after progression on endocrine therapy and CDK4/6 inhibitor, these agents make up now additional treatment options for such patients.

The only other chemotherapy-free alternative I would consider in this scenario would be continuing fulvestrant but adding everolimus. This combination has shown efficacy in patients who progressed on AI by doubling median PFS from 5.1 to 10.3 months based on PrE0102 Phase II study. However, we don't...