Case 1: Dr. Tanya Gupta presented a metastatic ER-positive case highlighted biomarker-guided therapy. Panelists favored capivasertib plus fulvestrant for PIK3CA-mutant disease and stressed biomarkers to optimize treatment and cost-effectiveness.

Case 2: Dr. Alexis LeVee presented a metastatic ER+/HER2- case with an ESR1 mutation highlighted personalized second-line therapy, balancing efficacy, toxicity, and patient preferences while underscoring the need for better predictive biomarkers.

Case 3: Dr. Hemali Batra-Sharma presented a metastatic ER+/HER2- case with an ESR1 mutation emphasized individualized second-line therapy, combining endocrine agents with targeted treatments while considering toxicity, patient preferences, and evolving biomarkers.

Case 4: Dr. Kay Yeung presented a metastatic ER-positive case explored ctDNA-guided monitoring and the SERENA-6 strategy, highlighting earlier treatment adaptation, prolonged progression-free survival, and delayed chemotherapy.

Panelists discussed PI3K and ESR1 mutations as drivers of resistance, emphasizing early detection, targeted therapy, and careful monitoring before changing treatment in the absence of clinical progression.