What would be your next treatment in a postmenopausal woman with metastatic ER+ lobular cancer with progression on palbociclib/letrozole with multiple liver metastasis?

Topics: Breast Cancer • Medical Oncology

She is otherwise asymptomatic and no LFT abnormalities. Would you switch to chemotherapy or offer different endocrine therapy?

Answer from: Medical Oncologist at Academic Institution

I will assume this patient achieved median PFS and DOR as seen in first line studies with AI/CDKi prior to her progression. Some options for next line treatment include:1) Fulvestrant single agent2) Fulvestrant + everolimus / Exemestane + Everolimus3) Fulvestrant + alternate CDKi (preferab...

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Medical Oncologist at Florida Cancer Specialists
2 points: 1. PFS prolongation with alpelisib seen...

Answer from: Medical Oncologist at Community Practice

This is not an uncommon scenario. I usually switch to oral Capecitabine when patients progress on a CDK4/6 inhibitor-based therapy (when they have multiple liver mets). You can also attempt to get more out of endocrine-based therapy using Everolimus in combination with an aromatase inhibitor (if pat...

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Medical Oncologist at NYU Winthrop Hospital
Capecitabine is more toxic . I prefer endocrine t...

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