What would be your next treatment in a postmenopausal woman with metastatic ER+ lobular cancer with progression on palbociclib/letrozole with multiple liver metastasis?

I will assume this patient achieved median PFS and DOR as seen in first line studies with AI/CDKi prior to her progression. Some options for next line treatment include:

1) Fulvestrant single agent

2) Fulvestrant + everolimus / Exemestane + Everolimus

3) Fulvestrant + alternate CDKi (preferably on tria...

This is not an uncommon scenario. I usually switch to oral Capecitabine when patients progress on a CDK4/6 inhibitor-based therapy (when they have multiple liver mets). You can also attempt to get more out of endocrine-based therapy using Everolimus in combination with an aromatase inhibitor (if pat...