Precision therapy in metastatic breast cancer: the current landscape of molecular alteration-based therapies.

Breast cancer is the most commonly diagnosed cancer in women globally and remains the leading cause of cancer-related death among women. De novo metastatic breast cancer accounts for 5-10% of annual diagnoses, and approximately 30% of women with early-stage disease will eventually experience metastatic recurrence. Median survival varies by tumor subtype: 64-68 months for hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative cancers, 57-60 months for HER2-positive cancers, and around 13 months for triple-negative cancers. While current treatments-including chemotherapy, antibody-drug conjugates, endocrine therapy, HER2-targeted therapies, and immunotherapy-have significantly improved outcomes, resistance and disease progression remain ongoing challenges. Advances in next-generation sequencing (NGS) have enabled the identification of molecular alterations amenable to targeted therapy, underscoring the need for continued research into novel therapeutic targets. As more targeted agents become available and others are in development, staying informed about emerging targetable molecular alterations is increasingly essential. This review aims to summarize current data on targetable molecular alterations in metastatic breast cancer, focusing on available therapeutic options, key clinical trials, and practical insights for oncologists to support informed decision-making.