Breast cancer (invasive) · line 2 · Fulvestrant + everolimus (HR+/HER2- metastatic post-AI/CDK4/6i, no targetable mutation)
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
Knowledge-base record for audit. Provisional clinical content: this is not a prescription. An oncologist must verify original sources, applicability and review status. Full rules and constraints are in the YAML.
| Line of therapy | 2 |
|---|---|
| Track | standard |
| Linked regimen | REG-FULVESTRANT-EVEROLIMUS-BREAST |
| ID | IND-BREAST-HR-POS-2L-FUL-EVEROLIMUS |
|---|---|
| Type | Indication |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | DIS-BREAST |
| Sources | SRC-BOLERO2-BASELGA-2012 SRC-ESMO-BREAST-METASTATIC-2024 SRC-NCCN-BREAST-2025 |
Notes
ESCAT IB (no biomarker gating; broad applicability). Default 2L HR+/HER2- when no targetable mutation found (no PIK3CA / AKT1 / PTEN alteration → no capivasertib/alpelisib; no ESR1 mutation → no elacestrant) and HER2-low not actionable / T-DXd not available. Pivotal trial BOLERO-2 used everolimus + exemestane; PrECOG 0102 validated fulvestrant substitution (mechanistically equivalent; preferred when fulvestrant already in use). Stomatitis prophylaxis with dexamethasone mouthwash (SWISH) reduces G2+ stomatitis from ~33% to ~2% — mandatory pre-medication. Pneumonitis (~16% any grade) and immunosuppression-related infections require monitoring. UA access: everolimus registered (generics + brand Afinitor) but NSZU does not cover breast indication — out-of-pocket; generic substantially cheaper.
Used By
Algorithms
ALGO-BREAST-HR-POS-2L- ALGO-BREAST-HR-POS-2L
Handbook Chapters
HB-BREAST-HR-POS-HER2-NEG-1L- HR+/HER2- metastatic breast cancer: first-line reasoning