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Elacestrant SERD — SCE Medical Oncology MCQ

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HardBreast CancerElacestrant SERDSCE Medical Oncology

A 62-year-old woman with ER+/HER2- metastatic breast cancer has an ESR1 D538G mutation detected on ctDNA after progression on AI + CDK4/6i. She asks about elacestrant. What is this drug?

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Correct answer: C — Elacestrant is an oral selective oestrogen receptor degrader (SERD) with activity against ESR1-mutant ER — the EMERALD trial showed PFS benefit over standard endocrine therapy in ESR1-mutant, ER+ MBC after prior CDK4/6i and ET

Elacestrant is a next-generation oral SERD that degrades both wild-type and ESR1-mutant ER, unlike fulvestrant (injectable SERD with limited activity against some ESR1 mutations). The EMERALD trial showed elacestrant improved PFS vs standard ET in ER+/HER2- MBC with ESR1 mutations after prior CDK4/6i and ≥1 line of ET. It offers an oral, mutation-targeted endocrine approach. NICE appraisal is pending. This represents the evolving landscape of endocrine resistance management guided by ctDNA ESR1 testing.

Reference: ESMO 2024 MBC; EMERALD Bidard et al JAMA Oncol 2022