PIK3CA Mutation?
Tamoxifen,
Aromatase
Inhibitor, or
Fulvestrant +
Alpelisib* as
second line
therapy
YES
Tamoxifen,
Aromatase
Inhibitor, or
Fulvestrant
±Everolimus as
second line therapy
NO
Tamoxifen,
aromatase inhibitor,
or fulvestrant (with
targeted therapy if
not already given)
or chemotherapy as
third line therapy
Fulvestrant + Alpelisib*
as second line therapy
Chemotherapy or any
one of the following
(with targeted
therapy if not already
given): tamoxifen,
aromatase inhibitor,
or fulvestrant as third
line therapy