Opinion|Videos|October 6, 2026
Clinical Scenario: Limits of Endocrine Therapy and Closing Remarks
Neil Iyengar, MD, presents a second case: a 61-year-old woman with HER2-low metastatic breast cancer who progressed after 22 months on first-line palbociclib and letrozole and 8 months of subsequent endocrine therapy, now with an ESR1 and PIK3CA H1047R co-mutation.
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Neil Iyengar, MD, presents a second case: a 61-year-old woman with HER2-low metastatic breast cancer who progressed after 22 months on first-line palbociclib and letrozole and 8 months of subsequent endocrine therapy, now with an ESR1 and PIK3CA H1047R co-mutation. Rebecca Shatsky, MD, favors trying another oral selective estrogen receptor degrader with close scan follow-up before moving to chemotherapy. Carol Tweed, MD, says either capivasertib plus fulvestrant or elacestrant plus abemaciclib is reasonable, and sets expectations with patients about modest additional benefit given prior treatment duration. Both panelists agree sequencing ESR1-directed and PI3K-directed therapy before an antibody-drug conjugate is reasonable in a patient who remains well. Closing the program, Dr. Iyengar thanks Dr. Shatsky and Dr. Tweed for a discussion spanning aromatase inhibitor biology, SERENA-6 data, and practical strategies for ctDNA-guided treatment switching.
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