NOT FINISHED Metastatic Hormone Receptor Positive Breast Cancer Management

Question 1

What are the first line options for HR+ MCB?

Answer 1

1. ET + CDK4/6 inhibitor
2. Single agent CT if rapid response needed e.g. imminent organ failure

Question 2

What should be given in HER2 low?

Answer 2

If at least one line of chemotherapy tried should try trastuzumab deruxtecan

Question 3

Which trial advises trastuzumab deuxtecan (enhertu)?

Answer 3

DESTINY-04
median OS 23.4 vs 16 months
median PFS 9.9 vs 5.1 months

Question 4

What are the second line options in HR+ BCM if no additional markers or mutations?

Answer 4

1. Evrolimus + exemestane
2. Evrolimus + fulvestrant - ESR1 mutation
3. Fulvestrant monotherapy
4. Change ET and CDK4/6 inhibitor

If unlikely to tolerate evrolimus + exemestane the Capecitabine is an option (Jerusulum 2018)

Question 5

What is the trial evidence for Evrolimus (+exemestane)?

Answer 5

BOLERO-2

PFS 7.2 vs 3.2 months
No OS or QoL

Question 6

What is the second line option for HR+ MCB if PIK2CAm is positive?

Answer 6

Fulvestrant - alpelisib

Should be avoided in diabetics

Question 7

What is fulvestrant?

Answer 7

selective oestrogen receptor degrader

Question 8

What is the trial evidence for fulvestrant + alpelisib?

Answer 8

SOLAR-1
PFS 11 months vs 5.7
OS 39.4 vs 31 months