The Fellow on Call: The Heme/Onc Podcast Episode 065: Breast Cancer Series, Pt. 10-ER+, Metastatic Breast Cancer
Jul 19, 2023
The discussion shifts to metastatic ER+ breast cancer, emphasizing the significance of re-biopsy during disease progression. It covers treatment strategies, including endocrine therapy alongside CDK4/6 inhibitors to enhance progression-free survival. Insights on second-line targeted therapies, such as CERDs and PIK3CA inhibitors, are shared. The podcast also explores innovative approaches like antibody-drug conjugates and single-agent chemotherapy options. Key recommendations focus on prioritizing clinical trials and individualized treatment plans.
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ER+ Cancer Has Persistent Late Recurrence Risk
- Hormone receptor–positive breast cancer carries a steady ~1% per year risk of distant recurrence for up to 20 years.
- This explains why ER+ disease often relapses late compared with HER2+ or triple-negative subtypes.
Always Rebiopsy Metastatic Disease
- Always biopsy a metastatic site to confirm phenotype and guide therapy.
- Test for ESR1 and PIK3CA because they can change management in metastatic ER+ disease.
ESR1 Mutation Drives AI Resistance
- ESR1 mutations cause resistance to aromatase inhibitors by activating the estrogen receptor.
- These mutations appear in ~15–20% of metastatic patients and favor CERD strategies like fulvestrant or elacestrant.