Everolimus + Exemestane (HR+/HER2- breast 3L+, post CDK4/6i and PI3Ki/AKTi)
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.
| Components | DRUG-EVEROLIMUS DRUG-EXEMESTANE |
|---|
| ID | REG-EVEROLIMUS-EXEMESTANE |
|---|---|
| Type | Regimen |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | None declared |
| Sources | SRC-BOLERO2-BASELGA-2012 SRC-ESMO-BREAST-METASTATIC-2024 SRC-NCCN-BREAST-2025 |
Notes
BOLERO-2 (Baselga 2012, NEJM): everolimus + exemestane vs exemestane alone in HR+ MBC progressing on non-steroidal AI — mPFS 7.8 vs 3.2 mo. Now positioned 3L+ in the era of CDK4/6i (1L) and PI3K/AKT inhibitors (alpelisib for PIK3CA-mut, capivasertib for AKT-pathway alterations). Stomatitis is dominant toxicity — dexamethasone mouthwash prophylaxis (SWISH trial, Rugo 2017) is mandatory and dramatically reduces G2+ stomatitis. Pneumonitis (1-2% G3) requires prompt recognition. Useful for endocrine-sensitive disease where CDK4/6i + AI/fulvestrant has failed; alternative to chemo in slowly-progressive ER+ MBC.
Used By
Handbook Chapters
HB-BREAST-HR-POS-HER2-NEG-1L- HR+/HER2- metastatic breast cancer: first-line reasoning
Indication
IND-BREAST-HR-POS-3L-POST-CDK46I-POST-AKT- IND-BREAST-HR-POS-3L-POST-CDK46I-POST-AKT