How would you treat a patient with symptomatic and rapidly progressing metastatic HR+, HER2 low breast cancer with PIK3CA WT, ESR1 mutated, TMB high after progression on CDK 4/6 inhibitor, a taxane, and T-DXd?  

With disease progressing on increasing number of systemic therapy lines, the likelihood of having a response diminishes. In the absence of an impending organ crisis, one could consider fulvestrant with alpelisib, elacestrant, or pembrolizumab. However, if the patient is facing an impending organ fai...