Treatment
Figure 1. Algorithm for Endocrine Treatment and Targeted
Therapy for HR positive, HER2 negative Metastatic
Breast Cancer
Postmenopausal patients, and male
patients, with HR positive, HER2 negative,
advanced or metastatic breast cancer
Aromatase
Inhibitor + CDK
4/6 Inhibitor as
first line therapy
Fulvestrant + CDK 4/6
Inhibitor as first line
therapy
* Patients receiving alpelisib should have laboratory and symptom monitoring weekly for the first
four weeks of therapy in ord er to avoid serious toxicity.
Treated
with Adjuvant
Aromatase
Inhibitor?
YES
NO
PIK3CA
Mutation?
YES
Fulvestrant
±Everolimus as
second line therapy
NO
Germline BRCA
1/2 Mutation
Oral PARP inhibitor as
monotherapy may be
offered in the first through
third line setting
YES
