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.

Source YAML: complete record

Components	`DRUG-FULVESTRANT` `DRUG-EVEROLIMUS`

ID	`REG-FULVESTRANT-EVEROLIMUS-BREAST`
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

Pivotal trial: BOLERO-2 used everolimus + exemestane (PFS 10.6 vs 4.1 mo). PrECOG 0102 (Kornblum 2018) substituted fulvestrant for exemestane (PFS 10.3 vs 5.1 mo) — mechanistically equivalent and preferred when fulvestrant already in use. Stomatitis prophylaxis with dexamethasone mouthwash (SWISH) reduces G2+ stomatitis from ~33% to ~2% — mandatory pre-medication. Used as default 2L when no PIK3CA/AKT1/PTEN/ESR1 alteration is found and HER2-low not available; no biomarker gating.

Used By

Indication

IND-BREAST-HR-POS-2L-FUL-EVEROLIMUS - IND-BREAST-HR-POS-2L-FUL-EVEROLIMUS