Navigating the Evolving Landscape of Endocrine Therapy in Breast Cancer
Erika Hamilton, MD, discusses how to approach treatment after progression on first-line therapy and hormone receptor-positive breast cancer.
Erika Hamilton, MD, director of Breast Cancer Research at the Sarah Cannon Research Institute, discusses how to approach treatment after progression on first-line therapy and hormone receptor-positive breast cancer.
Hamilton explains that the approach to treating breast cancer with endocrine therapies has become increasingly complex. There are now several actionable steps depending on specific genetic mutations. For example, elacestrant, an oral selective estrogen receptor degrader (SERD), is available for patients with an ESR1 mutation. For those with PIK3CA or PTEN mutations, fulvestrant can be combined with alpelisib (Piqray). Additionally, she explains that patients with BRCA alterations can benefit from PARP inhibitors and other options are available for those without actionable mutations.
Transcription:
0:09 | It is way more complicated than it used to be. There are a few actionable things. Does the patient have an ESR1 mutation? If so, they are eligible for elacestrant, our oral SERD. Do they have a PIK3CA or PTEN mutation? Then they are eligible for fulvestrant in combination with alpelisib. If they have a PI3K alteration, fulvestrant can be combined with alpelisib [Piqray]. We also still have PARP inhibitors that are actionable for patients with BRCA alterations.
0:40 | For those with what I call a "bland profile," where there are no actionable mutations, we are not very happy with what fulvestrant alone offers. So, we have the option of using fulvestrant with everolimus, an older combination, or we have more data from the MONARCH-E trial [NCT03155997] suggesting there may be a benefit to continuing CDK4/6 inhibitors in the second-line. Specifically, in a switch strategy, if someone received palbociclib [Ibrance] or ribociclib [Kisqali] in the first-line, you might consider abemaciclib [Verzenio] in combination with fulvestrant in the second-line setting. What used to be pretty straightforward, where many patients got fulvestrant, has become much more complicated in recent years.
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