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Case Challenge: mBC With ESR1 and PIK3CA Mutations

CE / CME

Case Challenge: HR+/HER2- mBC Progression With Multiple Targetable Mutations (ESR1 and PIK3CA)

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Pharmacists: 0.50 contact hour (0.05 CEUs)

ABIM MOC: maximum of 0.50 Medical Knowledge MOC point

Physicians: maximum of 0.50 AMA PRA Category 1 Credit

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Released: April 06, 2026

Expiration: October 05, 2026

Pretest

Progress
1 2 3
Course Completed
Please answer the questions below.
1.

A 55-year-old woman with a history of de novo hormone receptor (HR)–positive/HER2-negative metastatic breast cancer (mBC) treated with ribociclib plus letrozole now presents with disease progression in her bones after 2 years on first-line therapy. Circulating tumor DNA (ctDNA) testing reveals an ESR1 D538G mutation with a PIK3CA alteration with no germline BRCA1/2 mutations.

At this time, which of the following are FDA-approved options suitable for this patient?

How confident are you in your answer?
2.

When engaging in shared decision-making with patients with HR-positive/HER2-negative breast cancer who are considering oral SERD therapy and counseling them on treatment-related adverse events to support adherence, which of the following adverse events occurred at similar rates with elacestrant and imlunestrant in their phase III trials?

How confident are you in your answer?