Selection of Second-Line Treatment (II)

Consensus Statement	Quality of Evidence	Strength of Rec.	Key Ref
1. Elacestrant is a treatment option for patients with ESR1-mutated ER-positive, HER2-negative advanced or metastatic breast cancer progressing after at least one line of endocrine therapy.	I	A	1
2. Tucidinostat plus exemestane might be consider for alternative treatment for ER-positive HER2-negative advanced or metastatic breast cancer.	II^a	A	2
3. Imlunestrant with or without abemaciclib is a treatment option for ESR1-mutated ER-positive, HER2-negative advanced or metastatic breast cancer with disease progression following at least one line of endocrine therapy. ^b	I	A	3
4. Giredestrant combined with everolimus is a treatment option for ER-positive, HER2-negative advanced or metastatic breast cancer after prior CDK4/6 inhibitor progression with endocrine therapy	I	B	4
5. Vepdegestrant, a proteolysis-targeting chimera (PROTAC) estrogen receptor degrader, is a treatment option for with ESR1-mutated ER-positive, HER2-negative advanced or metastatic breast cancer breast cancer progressing after at least one line of endocrine therapy.	I	B	5

References

Bidard FC, et al. Elacestrant… Versus Standard Endocrine Therapy… EMERALD Trial. J Clin Oncol. 2022.
Tucidinostat plus exemestane for postmenopausal patients… (ACE). Lancet Oncol. 2019.
Jhaveri KL, et al. Imlunestrant with or without Abemaciclib in Advanced Breast Cancer. N Engl J Med. 2025.
Mayer EL, et al. Giredestrant… + everolimus… evERA BC trial. 2025 ESMO.
Campone M, et al. Vepdegestrant, a PROTAC Estrogen Receptor Degrader, in Advanced Breast Cancer. N Engl J Med. 2025.