Balancing Efficacy and Quality of Life When Sequencing Oral SERDs in HR Positive Breast Cancer

This segment addresses practical decision making as multiple oral SERDs become available and how clinicians weigh efficacy against quality of life. The panel emphasizes comparing adverse event signatures not only by rate but by their impact on daily function. Key considerations include hepatic and gastrointestinal effects that require routine lab monitoring and symptom management, ocular effects such as transient photopsia that may distress patients and prompt baseline optometry assessment, stomatitis and mucosal toxicity seen with mTOR combinations that can be mitigated with dexamethasone mouthwash, and metabolic or cardiac signals including bradycardia that warrant periodic vital sign or lipid checks. Tolerability drives sequencing when clinical benefits are similar, with prior endocrine sensitivity and prior CDK4/6 exposure informing expected efficacy. Dose modification and proactive prophylaxis are highlighted as tools to preserve quality of life while maintaining therapeutic intent. Shared decision making and multidisciplinary support are critical to match the chosen agent to patient goals and comorbidity profile.