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      Advancements in Hormone Receptor-Positive Metastatic Breast Cancer : Episode 2

      Navigating Treatment After Progression: Testing, ESR1 Mutations and Tolerable Options

      June 2, 2025
      By Virginia Kaklamani, MD, DSc
      Megan Kruse, MD
      Opinion
      Video

      Panelists discuss how to approach second-line therapy decisions for patients with metastatic breast cancer, emphasizing the importance of biomarker testing, including ESR1 mutations, and considering patient-specific factors.

      EP: 1.Understanding Cancer Changes and Testing: How Testing Guides Your Metastatic Breast Cancer Treatment

      Now Viewing

      EP: 2.Navigating Treatment After Progression: Testing, ESR1 Mutations and Tolerable Options

      EP: 3.Exploring a Patient Case: Biomarker Testing After Progression and Discussing Treatment Choices With Your Care Team

      EP: 4.EMERALD Trial Results: What Prior CDK4/6i Duration Means for Treatment Success

      EP: 5.Managing Elacestrant Treatment: From Patient Selection to Supportive Care

      EP: 6.Real-World Experience: The Efficacy and Tolerability of Oral Elacestrant for Patients with ESR1 Mutations

      EP: 7.Patient Education, Shared Decision-Making, and Optimizing Care for ESR1-Mutated Breast Cancer

      Video content above is prompted by the following:

      Clinical Brief: Biomarker Testing Strategy in Second-Line Therapy

      Main Discussion Topics:

      • Strategic approach to biomarker testing when transitioning to second-line therapy
      • Importance of liquid biopsy versus tissue biopsy for ESR1 mutation detection
      • Role of PIK3CA and other pathway mutations in treatment selection
      • Shared decision-making process for selecting between multiple treatment options
      • Clinical assessment of endocrine sensitivity duration as a treatment predictor

      Key Points for Physicians:

      • Liquid biopsy preferred for ESR1 mutation detection due to subclonal nature (15%-20% better detection)
      • PIK3CA mutations are clonal and detectable in the initial tissue biopsy
      • Prior CDK4/6 inhibitor response duration greater than 12 months indicates endocrine sensitivity
      • Multiple treatment options require individualized patient assessment
      • Quality-of-life considerations balance with efficacy outcomes

      The discussion emphasized that endocrine resistance is a complex phenomenon involving multiple pathways, not just ESR1 mutations, requiring comprehensive biomarker assessment for optimal treatment selection.

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      Stay up to date on recent advances in oncology nursing and patient care.

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