ASCO GUIDELINES Bundle

HR-Positive, HER2-Negative Metastatic Breast Cancer Endocrine Treatment and Targeted Therapy

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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

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