Patient
BREAST-HR-2L-AKT1-001 · Algorithm: ALGO-BREAST-HR-POS-2L
Clinical significance of mutations (ESCAT)
Tumor-board context — the engine does not use these tiers to rank tracks
| Biomarker | Variant | ESCAT | Evidence | Clinical significance | Drugs | Sources |
|---|
| No clinically actionable variants matched in this profile. |
| Biomarker | Status |
|---|
| BIO-ER | Not in KB — ask clinician to verify |
| BIO-PR | Not in KB — ask clinician to verify |
| BIO-HER2-SOLID | Excluded (negative) |
| BIO-AKT1 | BIO definition in KB; no ESCAT BMA entry — verify with clinician |
Primary current-line option
- Indication
- IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB
- Regimen
- Capivasertib + fulvestrant (HR+/HER2- PIK3CA/AKT1/PTEN-altered metastatic post-AI/CDK4/6i)
- Drugs + NSZU
- Capivasertib (DRUG-CAPIVASERTIB) 400 mg PO BID, 4 days on / 3 days off (intermittent schedule) · Days 1-4, 8-11, 15-18, 22-25 of 28-day cycle · PO ✗ Not registered in UA
- Fulvestrant (DRUG-FULVESTRANT) 500 mg IM days 1, 15, 29, then monthly · Loading days 1, 15, 29; then q4w maintenance · IM ✓ NSZU covered
- Reason
- Primary current-line option selected by ALGO-BREAST-HR-POS-2L at step 1; branch-driving red flag: RF-BREAST-AKT1-E17K-ACTIONABLE.
Other current-line alternatives (5 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- Indication
- IND-BREAST-HR-POS-2L-PIK3CA-ALPELISIB
- Regimen
- Alpelisib + fulvestrant (HR+/HER2- PIK3CA-mutant metastatic post-AI/CDK4/6i)
- Drugs + NSZU
- Alpelisib (DRUG-ALPELISIB) 300 mg PO once daily with food · Continuous, no off-day · PO ⚠ Out-of-pocket
- Fulvestrant (DRUG-FULVESTRANT) 500 mg IM days 1, 15, 29, then monthly · Loading days 1, 15, 29; then q4w maintenance · IM ✓ NSZU covered
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-BREAST-HR-POS-2L-ESR1-ELACESTRANT
- Regimen
- Elacestrant monotherapy (HR+/HER2- ESR1-mutant metastatic post-AI/CDK4/6i)
- Drugs + NSZU
- Elacestrant (DRUG-ELACESTRANT) 345 mg PO once daily with food · Continuous, no off-day · PO ✗ Not registered in UA
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-BREAST-HR-POS-2L-T-DXD-HER2-LOW
- Regimen
- T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic)
- Drugs + NSZU
- Trastuzumab deruxtecan (T-DXd) (DRUG-TRASTUZUMAB-DERUXTECAN) 5.4 mg/kg IV · Day 1 of 21-day cycle, continuous until progression · IV ✓ NSZU covered
- Supportive care
- SUP-BONE-HEALTH-PROSTATE
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-BREAST-HR-POS-2L-FUL-EVEROLIMUS
- Regimen
- Fulvestrant + everolimus (HR+/HER2- metastatic post-AI/CDK4/6i, no targetable mutation)
- Drugs + NSZU
- Fulvestrant (DRUG-FULVESTRANT) 500 mg IM days 1, 15, 29, then monthly · Loading days 1, 15, 29; then q4w maintenance · IM ✓ NSZU covered
- Everolimus (DRUG-EVEROLIMUS) 10 mg PO once daily continuous · Continuous, no off-day · PO ⚠ Out-of-pocket
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-BREAST-BRCA-MET-TALAZOPARIB
- Regimen
- Talazoparib monotherapy (gBRCA-mutant HER2- locally advanced or metastatic breast)
- Drugs + NSZU
- Talazoparib (DRUG-TALAZOPARIB) 1 mg PO once daily continuous · Continuous, no off-day; reduce to 0.75 / 0.5 / 0.25 mg for AE management · PO ⚠ Out-of-pocket
- Reason
- Current-line alternative presented for HCP consideration
Why this branch was chosen
Triggers from the patient profile that fired and drove the chosen branch.
Step 1 → branch IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB
- RF-BREAST-AKT1-E17K-ACTIONABLE ★ winner: AKT1 E17K activating mutation in HR+/HER2- metastatic breast cancer — ~3-6% prevalence. Capivasertib + fulvestrant (CAPItello-291) is FDA-approved for HR+/HER2- advanced breast harboring PIK3CA / AKT1 / PTEN alteration after progression on endocrine ± CDK4/6i.
SRC-NCCN-BREAST-2025SRC-ESMO-BREAST-METASTATIC-2024SRC-CAPITELLO291-TURNER-2023
Pre-treatment investigations
Investigations before treatment start · critical / standard / desired · merged across tracks
| ID | Name | Priority | Category | Where to order | Needed for |
|---|
| TEST-CECT-CAP | CECT chest/abdomen/pelvis | Critical | imaging | — | all tracks |
| TEST-ER-PR-IHC | ER + PR immunohistochemistry on tumor | Critical | — | CSD Lab ✓ (code TBC) | all tracks |
| TEST-HER2-IHC-FISH | HER2 IHC + reflex FISH on tumor | Critical | — | CSD Lab ✓ (code TBC) | all tracks |
| TEST-GERMLINE-BRCA-PANEL | Germline BRCA1/2 + HRR panel sequencing | Standard | — | CSD Lab: M089 | all tracks |
| TEST-PIK3CA-NGS | PIK3CA mutation testing (tumor or ctDNA) | Standard | — | CSD Lab: M065 | all tracks |
Red flags — PRO / CONTRA aggressive
PRO-AGGRESSIVE
Triggers that push toward the aggressive track
- AKT1 E17K activating hotspot specifically positioning capivasertib + fulvestrant in HR+/HER2- metastatic breast post-endocrine ± CDK4/6i. CAPItello-291 (Turner 2023) enrolled patients with PIK3CA / AKT1 / PTEN-altered tumors; AKT1 E17K accounted for ~7% of the altered cohort. Capivasertib + fulvestrant mPFS 7.3 vs 3.1 mo (HR 0.50, p<0.001) in the altered population. AKT1 E17K is the dominant (>90%) AKT1 hotspot. Candidate RF specifically anchors the E17K → capivasertib pairing distinct from the broader RF-BREAST-AKT1-E17K-ACTIONABLE.
RF-BREAST-AKT1-E17K-CAPIVASERTIB-CANDIDATE
- HBV/HCV/HIV serology + dental evaluation pre-bisphosphonate/denosumab + DPYD genotyping for capecitabine-containing regimens (EU practice).RF-BREAST-INFECTION-SCREENING
- PIK3CA-mutant HR+/HER2- metastatic breast with co-alteration profile (endocrine-resistant biology — relapse on / within 12 months of adjuvant endocrine therapy OR de novo metastatic with rapid progression). INAVO120 (Jhaveri 2024) randomized first-line endocrine-resistant PIK3CA-mut HR+/HER2- MBC to inavolisib + palbociclib + fulvestrant vs placebo + palbociclib + fulvestrant (mPFS 15.0 vs 7.3 mo, HR 0.43, p<0.0001). Inavolisib is a next-gen PI3Kα-selective + mutant-specific degrader with reduced hyperglycemia vs alpelisib. Candidate RF positions the 1L INAVO120 triplet specifically — distinct from RF-BREAST-PIK3CA-MUT-ACTIONABLE (broad 2L+ pathway-altered class).
RF-BREAST-PIK3CA-COALT-INAVOLISIB-CANDIDATE
CONTRA-AGGRESSIVE
Hard contraindications to escalation
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Capivasertib + fulvestrant (HR+/HER2- PIK3CA/AKT1/PTEN-altered metastatic post-AI/CDK4/6i)
28-day cycles × Continuous until progression or unacceptable toxicity
Standard plan
Induction · Alpelisib + fulvestrant (HR+/HER2- PIK3CA-mutant metastatic post-AI/CDK4/6i)
28-day cycles × Continuous until progression or unacceptable toxicity
Standard plan
Induction · Elacestrant monotherapy (HR+/HER2- ESR1-mutant metastatic post-AI/CDK4/6i)
28-day cycles × Continuous until progression or unacceptable toxicity
Standard plan
Induction · T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic)
21-day cycles × Continuous until progression or unacceptable toxicity
Standard plan
Induction · Fulvestrant + everolimus (HR+/HER2- metastatic post-AI/CDK4/6i, no targetable mutation)
28-day cycles × Continuous until progression or unacceptable toxicity
Standard plan
Induction · Talazoparib monotherapy (gBRCA-mutant HER2- locally advanced or metastatic breast)
28-day cycles × Continuous until progression or unacceptable toxicity
MDT brief
Discussion questions (4, 2 blocking)
BLOCKING OQ-BIOMARKER-ESTROGEN-RECEPTOR
What is the status of Estrogen receptor (ER) (BIO-ESTROGEN-RECEPTOR)? It is required by track(s): IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB, IND-BREAST-HR-POS-2L-PIK3CA-ALPELISIB, IND-BREAST-HR-POS-2L-ESR1-ELACESTRANT, IND-BREAST-HR-POS-2L-T-DXD-HER2-LOW, IND-BREAST-HR-POS-2L-FUL-EVEROLIMUS, IND-BREAST-BRCA-MET-TALAZOPARIB. Expected value: positive.
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ pathologist
BLOCKING OQ-BIOMARKER-PTEN
What is the status of PTEN loss-of-function (BIO-PTEN)? It is required by track(s): IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB. Expected value: loss-of-function (biallelic NGS or complete IHC loss).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist
OQ-BIOMARKER-BRCA1-BRCA2-GERMLINE
What is the status of BRCA1/BRCA2 germline pathogenic variant (BIO-BRCA1-BRCA2-GERMLINE)? It is required by track(s): IND-BREAST-BRCA-MET-TALAZOPARIB. Expected value: pathogenic OR likely-pathogenic germline variant.
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist
OQ-BIOMARKER-ESR1
What is the status of ESR1 mutation (ligand-binding domain) (BIO-ESR1)? It is required by track(s): IND-BREAST-HR-POS-2L-ESR1-ELACESTRANT. Expected value: ligand-binding-domain mutation present (ctDNA preferred — D538G, Y537S, Y537N, Y537C, L536H, E380Q).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist
MDT talk tree (5 steps)
| # | Owner | Topic | Action |
|---|
| 1 | molecular_geneticist | Biomarker status BLOCKING | What is the status of PTEN loss-of-function (BIO-PTEN)? It is required by track(s): IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB. Expected value: loss-of-function (biallelic NGS or complete IHC loss). |
| 2 | pathologist | Biomarker status BLOCKING | What is the status of Estrogen receptor (ER) (BIO-ESTROGEN-RECEPTOR)? It is required by track(s): IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB, IND-BREAST-HR-POS-2L-PIK3CA-ALPELISIB, IND-BREAST-HR-POS-2L-ESR1-ELACESTRANT, IND-BREAST-HR-POS-2L-T-DXD-HER2-LOW, IND-BREAST-HR-POS-2L-FUL-EVEROLIMUS, IND-BREAST-BRCA-MET-TALAZOPARIB. Expected value: positive. |
| 3 | molecular_geneticist | Biomarker status | What is the status of BRCA1/BRCA2 germline pathogenic variant (BIO-BRCA1-BRCA2-GERMLINE)? It is required by track(s): IND-BREAST-BRCA-MET-TALAZOPARIB. Expected value: pathogenic OR likely-pathogenic germline variant. |
| 4 | molecular_geneticist | Biomarker status | What is the status of ESR1 mutation (ligand-binding domain) (BIO-ESR1)? It is required by track(s): IND-BREAST-HR-POS-2L-ESR1-ELACESTRANT. Expected value: ligand-binding-domain mutation present (ctDNA preferred — D538G, Y537S, Y537N, Y537C, L536H, E380Q). |
| 5 | social_worker_case_manager | Specialist review | Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed. |
Skills (recommended) — for consideration (2)
- Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Owns: OQ-BIOMARKER-PTEN, OQ-BIOMARKER-BRCA1-BRCA2-GERMLINE, OQ-BIOMARKER-ESR1
- Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.
Data quality
Incomplete for default-track review. Default-track review is incomplete until required biomarker gaps are resolved.
- Biomarker coverage: 3/7 known (43%), 4 missing, 2 default-track gaps
- Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-BREAST-AKT1-E17K-CAPIVASERTIB-CANDIDATE, RF-BREAST-BRCA-GERMLINE-ACTIONABLE, RF-BREAST-CDH1-LOBULAR-CANDIDATE, RF-BREAST-EARLY-STAGE, RF-BREAST-ESR1-MUT-ACTIONABLE, RF-BREAST-ESR1-Y537S-D538G-CANDIDATE, RF-BREAST-FRAILTY-AGE, RF-BREAST-HER2-AMP-ACTIONABLE, RF-BREAST-HER2-LOW-ACTIONABLE, RF-BREAST-HER2-ULTRALOW-CANDIDATE, RF-BREAST-HIGH-RISK-BIOLOGY, RF-BREAST-INFECTION-SCREENING, RF-BREAST-ORGAN-DYSFUNCTION, RF-BREAST-OVARIAN-HRD-ASSAY-DISTINCTION, RF-BREAST-PIK3CA-COALT-INAVOLISIB-CANDIDATE, RF-BREAST-PIK3CA-MUT-ACTIONABLE, RF-BREAST-STAGE-IV-METASTATIC, RF-BREAST-TNBC, RF-BREAST-TRANSFORMATION-PROGRESSION, RF-PAN-ATM-CHEK2-CDK12-PARPI-CANDIDATE, RF-PAN-BRCA-SOMATIC-PARPI-CANDIDATE, RF-PAN-PALB2-PARPI-CANDIDATE
| Missing biomarker | Label | MDT owner | Default track | Required by | Next action |
|---|
BIO-ESTROGEN-RECEPTOR | Estrogen receptor (ER) | pathologist | yes | IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB, IND-BREAST-HR-POS-2L-PIK3CA-ALPELISIB, IND-BREAST-HR-POS-2L-ESR1-ELACESTRANT, IND-BREAST-HR-POS-2L-T-DXD-HER2-LOW, IND-BREAST-HR-POS-2L-FUL-EVEROLIMUS, IND-BREAST-BRCA-MET-TALAZOPARIB | Verify result, method, specimen, and report date before sign-off. Expected/constraint: positive |
BIO-PTEN | PTEN loss-of-function | molecular_geneticist | yes | IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB | Verify result, method, specimen, and report date before sign-off. Expected/constraint: loss-of-function (biallelic NGS or complete IHC loss) |
BIO-BRCA1-BRCA2-GERMLINE | BRCA1/BRCA2 germline pathogenic variant | molecular_geneticist | no | IND-BREAST-BRCA-MET-TALAZOPARIB | Verify result, method, specimen, and report date before sign-off. Expected/constraint: pathogenic OR likely-pathogenic germline variant |
BIO-ESR1 | ESR1 mutation (ligand-binding domain) | molecular_geneticist | no | IND-BREAST-HR-POS-2L-ESR1-ELACESTRANT | Verify result, method, specimen, and report date before sign-off. Expected/constraint: ligand-binding-domain mutation present (ctDNA preferred — D538G, Y537S, Y537N, Y537C, L536H, E380Q) |
Technical MDT skill metadata (2/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
| Specialist | skill_id | Version | Last reviewed | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-BOLERO2-BASELGA-2012: Everolimus in Postmenopausal Hormone-Receptor-Positive Advanced Breast Cancer (2012)
- SRC-CAPITELLO291-TURNER-2023: Capivasertib in Hormone Receptor-Positive Advanced Breast Cancer (2023)
- SRC-DESTINY-BREAST04-MODI-2022: Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer (2022)
- SRC-EMBRACA-LITTON-2018: Talazoparib in Patients with Advanced Breast Cancer and a Germline BRCA Mutation (2018)
- SRC-EMERALD-BIDARD-2022: Elacestrant (Oral Selective Estrogen Receptor Degrader) Versus Standard Endocrine Therapy for Estrogen Receptor-Positive, HER2-Negative Advanced Breast Cancer: Results from the Randomized Phase III EMERALD Trial (2022)
- SRC-ESMO-BREAST-METASTATIC-2024: ESMO Clinical Practice Guideline on Metastatic Breast Cancer (2024)
- SRC-NCCN-BREAST-2025: NCCN Clinical Practice Guidelines — Breast Cancer (2025.v4)
- SRC-SOLAR1-ANDRE-2019: Alpelisib for PIK3CA-Mutated, Hormone Receptor-Positive Advanced Breast Cancer (2019)
Experimental options (clinical trials)
Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-05-12.
| NCT | Title | Phase | Status | Sponsor | UA | Signals | Eligibility (excerpt) |
|---|
| NCT05607004 | (Z)-Endoxifen for the Treatment of Premenopausal Women With ER+/HER2- Breast Cancer | PHASE2 | RECRUITING | — | Biomarker: enriched Surrogate endpoint only Single country | |
| NCT06763328 | Metformin for the Treatment of Insulin Resistance in Women With Stage I-III Breast Cancer Completing Chemotherapy | PHASE3 | RECRUITING | — | Biomarker: enriched Single country | |
| NCT05183828 | Effect of HSD3B1 (1245C) Gene Mutation on Treatment of Stage I-III Breast Cancer | PHASE4 | RECRUITING | — | Biomarker: enriched Single country | |
| NCT06092892 | IIT2023-09-Chung-UpfrontTAD: Upfront TAD/SNB in Patients With Breast Cancer With Nodal Metastases | PHASE2 | RECRUITING | — | Biomarker: enriched Small N (<50) Single country | |
| NCT06666439 | Longitudinal Tumor Burden Quantification Using Circulating Tumor DNA in Metastatic Lobular Breast Cancer | N/A | RECRUITING | — | Biomarker: enriched Small N (<50) Single country | |
| NCT04660435 | To Identify Primary Resistance to CDK4/6 Inhibitors in Breast Cancer | N/A | RECRUITING | — | Biomarker: enriched Surrogate endpoint only Single country | |
| NCT04230109 | Sacituzumab Govitecan In TNBC | PHASE2 | RECRUITING | — | Biomarker: enriched Single country | |
| NCT06067503 | Biomarkers to Detect Endocrine Therapy Resistance | PHASE2 | RECRUITING | — | Biomarker: enriched Small N (<50) Single country | |
| NCT07483307 | A Study of the Impact of Endocrine Therapy on Surgical Outcomes in People With Breast Cancer | PHASE2 | RECRUITING | — | Biomarker: enriched Single country | |
| NCT05059444 | ORACLE: Observation of ResiduAl Cancer With Liquid Biopsy Evaluation | N/A | RECRUITING | — | Biomarker: enriched | |
Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.
Option availability in Ukraine
Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).
| Option | UA registration | NSZU | Cost orientation | Access pathway |
|---|
| Standard plan Capivasertib + fulvestrant (HR+/HER2- PIK3CA/AKT1/PTEN-altered metastatic post-AI/CDK4/6i) (REG-CAPIVASERTIB-FULVESTRANT-BREAST) 1/2 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Alpelisib + fulvestrant (HR+/HER2- PIK3CA-mutant metastatic post-AI/CDK4/6i) (REG-ALPELISIB-FULVESTRANT-BREAST) 1/2 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Elacestrant monotherapy (HR+/HER2- ESR1-mutant metastatic post-AI/CDK4/6i) (REG-ELACESTRANT-BREAST) 1/1 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic) (REG-TDXD-METASTATIC) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Standard plan Fulvestrant + everolimus (HR+/HER2- metastatic post-AI/CDK4/6i, no targetable mutation) (REG-FULVESTRANT-EVEROLIMUS-BREAST) 1/2 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Talazoparib monotherapy (gBRCA-mutant HER2- locally advanced or metastatic breast) (REG-TALAZOPARIB-MONO-BREAST) 1/1 component drug(s) not on NSZU formulary | ✓ registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Trial · NCT05607004 (Z)-Endoxifen for the Treatment of Premenopausal Women With ER+/HER2- Breast Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06763328 Metformin for the Treatment of Insulin Resistance in Women With Stage I-III Breast Cancer Completing Chemotherapy No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05183828 Effect of HSD3B1 (1245C) Gene Mutation on Treatment of Stage I-III Breast Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06092892 IIT2023-09-Chung-UpfrontTAD: Upfront TAD/SNB in Patients With Breast Cancer With Nodal Metastases No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06666439 Longitudinal Tumor Burden Quantification Using Circulating Tumor DNA in Metastatic Lobular Breast Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT04660435 To Identify Primary Resistance to CDK4/6 Inhibitors in Breast Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT04230109 Sacituzumab Govitecan In TNBC No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06067503 Biomarkers to Detect Endocrine Therapy Resistance No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT07483307 A Study of the Impact of Endocrine Therapy on Surgical Outcomes in People With Breast Cancer No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05059444 ORACLE: Observation of ResiduAl Cancer With Liquid Biopsy Evaluation No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-12.