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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
Course Completed
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. Her HER2 status is IHC 0 with no membrane staining.
At this time, which of the following are FDA-approved options suitable for this patient?

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?