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5 treatment settings, 5 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Elacestrant (EMERALD), imlunestrant (EMBER-3) or vepdegestrant; where available, a switch to camizestrant at the moment ESR1 appears in plasma while continuing the CDK4/6 inhibitor (SERENA-6).
Elacestrant was the first oral oestrogen-receptor degrader (2023), for ESR1-mutant breast cancer detected by blood test.
Imlunestrant is Lilly's oral oestrogen-receptor degrader, approved in 2025 for ESR1-mutant breast cancer and shown to work with abemaciclib regardless of mutation.
Camizestrant is an oral oestrogen-receptor degrader approved in September 2026 for a new kind of decision: switching treatment when a blood test shows resistance developing, before the cancer visibly grows.
Vepdegestrant is the first PROTAC ever approved (2026): a pill that tags the oestrogen receptor for destruction, for breast cancers with ESR1 mutations.
A blood test that reads fragments of DNA shed by the tumour, so you can genotype or monitor cancer without a needle in the tumour.
PFS HR 0.55 in ESR1-mutant.
PFS HR 0.62 (ESR1-mutant, monotherapy); HR 0.57 (combination vs monotherapy).
PFS 16.0 vs 9.2 months, HR 0.44.
Add these to your appointment list, or take the full question set for this cancer.
Capivasertib with fulvestrant (CAPItello-291); alpelisib with fulvestrant for PIK3CA (SOLAR-1); inavolisib with palbociclib and fulvestrant for PIK3CA-mutant disease relapsing during or soon after adjuvant endocrine therapy (INAVO120).
Capivasertib (Truqap) is the first AKT inhibitor, for breast cancer with PI3K-pathway mutations and, since 2026, for prostate cancer with PTEN loss.
Alpelisib was the first PI3K drug for PIK3CA-mutant breast cancer (2019). It is effective, but high blood sugar and rash limited its use, and newer drugs are displacing it.
Inavolisib is a PI3K drug that also destroys the mutant protein, approved in 2024 with palbociclib and fulvestrant for PIK3CA-mutant breast cancer.
Fulvestrant is a monthly intramuscular injection that degrades the oestrogen receptor rather than blocking it, the endocrine backbone paired with CDK4/6, PI3K and AKT inhibitors once aromatase inhibitors fail. Slow uptake and incomplete receptor degradation drove the search for oral degraders.
PFS HR 0.60 overall; HR 0.50 in AKT-pathway-altered.
PFS 11.0 vs 5.7 months, HR 0.65 (PIK3CA-mutant).
PFS 15.0 vs 7.3 months, HR 0.43; OS 34.0 vs 27.0 months, HR 0.67.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Cutaneous adverse reactions · CAPItello-291 | 56% | 15% |
| Diarrhoea · CAPItello-291 | 77% | 12% |
| Fatigue · CAPItello-291 | 38% | 1.9% |
| Stomatitis · CAPItello-291 | 25% | 1.9% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Fulvestrant with abemaciclib (postMONARCH), everolimus with exemestane, or another endocrine agent; giredestrant with everolimus is emerging (evERA).
Abemaciclib was the first CDK4/6 inhibitor approved after surgery for high-risk hormone-positive breast cancer.
An mTOR-blocking pill that doubled progression-free time with exemestane in 2012 and is now paired with the oral SERD giredestrant.
Exemestane is a steroidal aromatase inhibitor, the partner of everolimus and the agent tested with ovarian suppression in young women.
PFS 6.0 vs 5.3 months, HR 0.73.
PFS HR 0.56 (ITT); HR 0.38 (ESR1-mutant).
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · 37-46% any grade; 19-32% grade 3-4 | 42% | 19% |
| Diarrhoea · 81-90% any grade; 8-20% grade 3 across trials | 85% | 8% |
| Infections · monarchE / MONARCH 2 | - | 3% |
| Venous thromboembolism · 2-5% across trials | - | 2% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Trastuzumab deruxtecan before chemotherapy (DESTINY-Breast06), then sacituzumab govitecan (TROPiCS-02) or datopotamab deruxtecan (TROPION-Breast01) after chemotherapy.
Trastuzumab deruxtecan (Enhertu) is the most successful ADC ever. It redefined HER2 by working in tumours with only tiny amounts of the protein, and in 2026 moved into early-stage breast cancer.
The first TROP2-targeted ADC. It delivers a strong chemotherapy directly to breast and bladder cancer cells and is now a first-line option in triple-negative breast cancer.
Datopotamab deruxtecan (Datroway) is the second TROP2 ADC and shares Enhertu's payload. In 2026 it became a first-line option for triple-negative breast cancer patients who cannot receive immunotherapy.
PFS HR 0.62.
OS 14.4 vs 11.2 months, HR 0.79.
PFS HR 0.63; OS HR 1.01.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 18% |
| Nausea · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Anaemia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Fatigue · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia (grade 3 or higher) · ASCENT, sacituzumab arm; 33 percent with chemotherapy | - | 51% |
| Neutropenia · ASCENT, Trodelvy arm, n=258 | 78% | 49% |
| Diarrhoea · ASCENT, Trodelvy arm, n=258 | 59% | 11% |
| Diarrhoea (grade 3 or higher) · ASCENT; below 1 percent with chemotherapy | - | 10% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Stomatitis · TROPION-Breast01, n=360 | 59% | 7% |
| Fatigue · TROPION-Breast01, n=360 | 44% | 4.2% |
| Nausea · TROPION-Breast01, n=360 | 56% | 1.4% |
| Keratitis · TROPION-Breast01, n=360 | 24% | 1.1% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Olaparib (OlympiAD) or talazoparib (EMBRACA) in place of chemotherapy.
Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.
Talazoparib is a PARP inhibitor that traps PARP on DNA about 100 times more strongly than olaparib, which is why it works at a 1 mg daily dose. It is approved for germline BRCA-mutant HER2-negative breast cancer and, with enzalutamide, for HRR-mutant castration-resistant prostate cancer; anaemia is its dominant side effect.
PFS 7.0 vs 4.2 months, HR 0.58; OS 19.3 vs 17.1 months, not significant.
PFS 8.6 vs 5.6 months, HR 0.54; OS HR 0.85, not significant.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Anaemia · OlympiA adjuvant, n=911 | 24% | 9% |
| Neutropenia · OlympiA adjuvant, n=911 | 16% | 5% |
| Leukopenia · OlympiA adjuvant, n=911 | 17% | 3% |
| Fatigue · OlympiA adjuvant, n=911 | 42% | 1.8% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.