A 56-Year-Old Woman with HR+/HER2- Metastatic Breast Cancer and Visceral Metastases

Virginia Kaklamani, MD, presents the case of a 56-year-old woman with HR+/HER2- metastatic breast cancer and visceral metastases.

Virginia Kaklamani, MD, DSc, reviews the presented case of a postmenopausal patient with breast cancer who develops metastases after adjuvant endocrine therapy ends, and explains that later treatment selection is difficult because of endocrine resistance and mutations causing more aggressive disease.

Virginia Kaklamani, MD, DSc, explains that in second-line treatment of metastatic HR+/HER2- breast cancer after CDK4/6 inhibitors, biomarker testing guides the choice between therapies based on the safety and resistance mutation profiles.

Subgroup analyses from the EMERALD trial show that oral SERD elacestrant may outperform standard endocrine therapy in metastatic breast cancer patients with bone or visceral metastases who previously received CDK4/6 inhibitors.

Virginia Kaklamani, MD, DSc, shares that in deciding second-line therapy for metastatic breast cancer after CDK4/6 inhibitors, endocrine sensitivity guides the choice between treatments based on ESR1/PIK3CA mutations and safety profiles with/without fulvestrant injections.

Virginia Kaklamani, MD, DSc, details that disease burden and location of metastases in patients with HR+/HER2- metastatic breast cancer guide approaches to management, with visceral metastases indicating potentially faster progression and more concerning symptoms.

Virginia Kaklamani, MD, DSc, explains that managing adverse events like fatigue, GI toxicity, and musculoskeletal pain in patients with HR+/HER2- metastatic breast cancer using approaches such as exercise, anti-nausea medication, acupuncture, and supplements is key to meeting the dual treatment goals of prolonging life and maintaining quality of life.

Virginia Kaklamani, MD, DSc, explains that key unmet needs in HR+/HER2- metastatic breast cancer include overcoming diverse mechanisms of endocrine resistance with genomic profiling and new agents like oral SERDs while managing side effects.