HR-Positive/HER2-Negative Metastatic Breast Cancer: Treatment Sequencing After Adjuvant Endocrine Therapy and Transitioning Beyond Endocrine-Based Approaches

Dr. Adam Brufsky and the panel conclude their discussion by examining the increasingly complex treatment landscape for patients with HR-positive/HER2-negative metastatic breast cancer who experience recurrence after receiving modern adjuvant therapies. Dr. Rita Nanda, Dr. Rebecca Shatsky, and Dr. Virginia Kaklamani explore how prior exposure to endocrine therapy, CDK4/6 inhibitors, and emerging endocrine agents may influence treatment selection in the metastatic setting. The faculty discuss the role of molecular profiling in guiding subsequent therapy choices and consider potential treatment options for patients without actionable genomic alterations. The conversation then focuses on one of the most important practical questions in clinical care: determining when to transition from endocrine-based strategies to chemotherapy or antibody-drug conjugates. The panel emphasizes the importance of assessing disease biology, pace of progression, symptom burden, and endocrine sensitivity while maintaining a personalized approach to treatment selection. The discussion highlights the ongoing challenge of maximizing the benefit of endocrine therapy while preserving future treatment options and optimizing long-term outcomes for patients with HR-positive/HER2-negative metastatic breast cancer.