How Should ESR1, PIK3CA, and ADC Sequencing Be Managed After CDK4/6 Therapy?

In this clip, Prof. Jin Yang asks Prof. Giuseppe Curigliano how to approach treatment selection after CDK4/6 inhibitor exposure, with a focus on PAM-pathway alterations, dual ESR1/PIK3CA mutations, and practical sequencing of different ADCs in HR-positive metastatic breast cancer. Prof. Jin Yang is Director of the Cancer Center and Director of the Precision Oncology Research Center at The First Affiliated Hospital of Xi'an Jiaotong University, and Medical Director of the Phase I Clinical Research Center. Prof. Yang is a Chief Physician, Professor, and Doctoral Supervisor with active leadership roles in breast cancer, oncology drug development, and precision oncology research in China. The responding expert is Prof. Giuseppe Curigliano of the University of Milano and the European Institute of Oncology. Prof. Curigliano is ESMO President-Elect and is internationally recognized for work in ADC development, biomarker-driven oncology, and personalized treatment strategies in breast cancer. Key highlights from this clip: ●How capivasertib-based treatment is viewed across different PAM-pathway alterations, including AKT, PTEN, and PIK3CA mutations ●Why regulatory approval has focused on mutant populations even though benefit signals were also seen in the ITT population ●How tumor burden, symptoms, and prior endocrine sensitivity may shape the choice between oral SERDs and PI3K/AKT-pathway targeted therapy ●Why dual ESR1 and PIK3CA mutations may still require individualized decision-making rather than a single fixed treatment rule ●How duration of prior CDK4/6 inhibitor exposure may influence post-progression treatment selection ●Why, in routine practice, different ADCs are often separated by intervening chemotherapy unless a clinical trial supports a different sequencing strategyThis video is intended for medical education and professional discussion. #MedJ #breastcancer #metastaticbreastcancer #HRPositiveBreastCancer #CDK46 #ESR1 #PIK3CA #AKT #PTEN #precisionmedicine #OralSERD #ADC #Capivasertib #medicaloncology