Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

A postmenopausal woman with ER-positive HER2-negative metastatic breast cancer progresses after 18 months of an aromatase inhibitor plus a CDK4/6 inhibitor. ctDNA shows an activating ESR1 mutation. Which oral endocrine treatment now has the matching NICE indication?

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Correct answer: C — Elacestrant

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

C is correct. NICE TA1036 recommends elacestrant for eligible postmenopausal women and men with activating ESR1-mutant ER-positive HER2-negative advanced breast cancer after at least 12 months of endocrine treatment including a CDK4/6 inhibitor. ESR1 mutation promotes ligand-independent receptor activity and resistance to further aromatase inhibition, so anastrozole is poorly matched. Tamoxifen, exemestane alone and megestrol acetate are endocrine options in other sequences but do not carry this mutation-defined appraisal. The 18-month interval is included because the NICE recommendation is narrower than the medicine’s broad marketing authorisation.

Reference: NICE TA1036 elacestrant recommendations: https://www.nice.org.uk/guidance/ta1036/chapter/1-Recommendations