HR-positive metastatic breast cancer after CDK4/6 inhibitors: lines of therapy
5 standard-of-care settings across 2 lines and 5 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | BRCA / HRD | ESR1 | HER2-low | PIK3CA / AKT / PTEN |
|---|---|---|---|---|---|
| Third line and beyond | · | · | · | 1 | · |
| Other settings | 1 | 1 | 1 | · | 1 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| HER2-low | Endocrine-refractory, HER2-low or ultralow | Trastuzumab deruxtecan before chemotherapy (DESTINY-Breast06), then sacituzumab govitecan (TROPiCS-02) or datopotamab deruxtecan (TROPION-Breast01) after chemotherapy. | 97 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | No targetable alteration | Fulvestrant with abemaciclib (postMONARCH), everolimus with exemestane, or another endocrine agent; giredestrant with everolimus is emerging (evERA). | 91 | ||
| BRCA / HRD | Germline BRCA carriers | Olaparib (OlympiAD) or talazoparib (EMBRACA) in place of chemotherapy. | 87 | ||
| ESR1 | ESR1-mutant disease after a CDK4/6 inhibitor | Elacestrant (EMERALD), imlunestrant (EMBER-3) or vepdegestrant; where available, a switch to camizestrant at the moment ESR1 appears in plasma while continuing the CDK4/6 inhibitor (SERENA-6). | 89 | ||
| PIK3CA / AKT / PTEN | PIK3CA, AKT1 or PTEN alteration | Capivasertib with fulvestrant (CAPItello-291); alpelisib with fulvestrant for PIK3CA (SOLAR-1); inavolisib with palbociclib and fulvestrant for PIK3CA-mutant disease relapsing during or soon after adjuvant endocrine therapy (INAVO120). | 88 |
Sequence and caution pairings
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.