Metastatic HR+ Breast Cancer

Authored by Open Medicine, published on 2026-02-21 06:32:34.0

Dr. Kevin Kalinsky, Director of the Breast Cancer Program at the Winship Cancer Institute, Emory University and the Oncology Brothers review their current treatment approach to "Metastatic Hormone Receptor Positive (HR+) Breast Cancer Treatment Algorithm: Dr. Kevin Kalinsky."

  1. Advanced / Metastatic Breast Cancer confirmed
    • ET (recurrence ≤12 mos of adj ET)
      • PIK3CA Mut+ Inavolisib + Palbo + Fulvestrant
        <p>INAVO120</p>
        • ESR1 mutation
          <p>EMERALD Phase III</p>
          • Elacestrant / Imlunestrant
            • T-DXd (HER2 IHC ultra-low/low)
              <p>DESTINY-Breast06</p>
            • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
              <p>TROPiCS-02</p>
            • Dato-DXd (post chemo)
              <p>TROPION-Breast01</p>
            • Chemo
        • PIK3CA mutation
          <p>SOLAR-1</p>
          • Alpelisib + Fulvestrant
            • Chemo
            • Dato-DXd (post chemo)
              <p>TROPION-Breast01</p>
            • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
              <p>TROPiCS-02</p>
            • T-DXd (HER2 IHC ultra-low/low)
              <p>DESTINY-Breast06</p>
        • PIK3CA / AKT1 / PTEN alteration
          <p>CAPItello-291</p>
          • Capivasertib + Fulvestrant
            • T-DXd (HER2 IHC ultra-low/low)
              <p>DESTINY-Breast06</p>
            • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
              <p>TROPiCS-02</p>
            • Dato-DXd (post chemo)
              <p>TROPION-Breast01</p>
            • Chemo
        • gBRCA mutation
          • PARPi
            • Chemo
            • Dato-DXd (post chemo)
              <p>TROPION-Breast01</p>
            • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
              <p>TROPiCS-02</p>
            • T-DXd (HER2 IHC ultra-low/low)
              <p>DESTINY-Breast06</p>
        • Everolimus + Exemestane Fulvestrant +/- CDK 4/6 inhibitor
          <p>BOLERO-2</p>
          • T-DXd (HER2 IHC ultra-low/low)
            <p>DESTINY-Breast06</p>
          • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
            <p>TROPiCS-02</p>
          • Dato-DXd (post chemo)
            <p>TROPION-Breast01</p>
          • Chemo
    • Endocrine Therapy + Abemaciclib OR Ribociclib
      • ESR1 mutation
        <p>EMERALD Phase III</p>
        • Elacestrant / Imlunestrant
          • T-DXd (HER2 IHC ultra-low/low)
            <p>DESTINY-Breast06</p>
          • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
            <p>TROPiCS-02</p>
          • Dato-DXd (post chemo)
            <p>TROPION-Breast01</p>
          • Chemo
      • PIK3CA mutation
        <p>SOLAR-1</p>
        • Alpelisib + Fulvestrant
          • Chemo
          • Dato-DXd (post chemo)
            <p>TROPION-Breast01</p>
          • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
            <p>TROPiCS-02</p>
          • T-DXd (HER2 IHC ultra-low/low)
            <p>DESTINY-Breast06</p>
      • PIK3CA / AKT1 / PTEN alteration
        <p>CAPItello-291</p>
        • Capivasertib + Fulvestrant
          • T-DXd (HER2 IHC ultra-low/low)
            <p>DESTINY-Breast06</p>
          • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
            <p>TROPiCS-02</p>
          • Dato-DXd (post chemo)
            <p>TROPION-Breast01</p>
          • Chemo
      • gBRCA mutation
        • PARPi
          • Chemo
          • Dato-DXd (post chemo)
            <p>TROPION-Breast01</p>
          • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
            <p>TROPiCS-02</p>
          • T-DXd (HER2 IHC ultra-low/low)
            <p>DESTINY-Breast06</p>
      • Everolimus + Exemestane Fulvestrant +/- CDK 4/6 inhibitor
        <p>BOLERO-2</p>
        • T-DXd (HER2 IHC ultra-low/low)
          <p>DESTINY-Breast06</p>
        • Sacituzumab govitecan (at least 2 prior lines of systemic rx)
          <p>TROPiCS-02</p>
        • Dato-DXd (post chemo)
          <p>TROPION-Breast01</p>
        • Chemo
tosprivacy