ESR1 mutations were detected in 30% (151/383) baseline samples. In patients with ESR1 mutation detected, PFS was 2.4 months (95%CI,2.0-2.6) on exemestane and 3.9 months (95%CI,3.0-6.0) on fulvestrant (HR=0.59, 95%CI,0.39-0.89; p=0.01). Patients with ESR1 mutation detected had one-year overall survival of 62% (95%CI,45%-75%) on exemestane and 80% (95%CI,68%-87%) on fulvestrant (p=0.04, restricted mean survival analysis).