The Evolving World of Oral SERDs: A Deep Dive into Patient Selection, Sequencing Strategies, and Emerging Data

A panelist discusses how testing for ESR1 mutations should be performed after every progression using liquid biopsies and how elacestrant is currently the only approved oral SERD that effectively targets these mutations.

A panelist discusses how the SERENA-6 study presented at ASCO 2025 showed that switching therapy early based on molecular progression (ESR1 mutation emergence) before radiological progression improved outcomes, with a 60% reduction in risk.

A panelist discusses how the landmark EMERALD study established elacestrant as an effective treatment for heavily pretreated patients with ESR1 mutations, showing 8 to 9 months median progression-free survival versus less than 2 months with standard care.

A panelist discusses how elacestrant should be used as soon as ESR1 mutations emerge, emphasizing that it works equally well in visceral and bone metastases and that ESR1 mutations must be targeted before other mutations due to their resistance-driving nature.

A panelist discusses how real-world studies of elacestrant showed even better outcomes than clinical trials, with progression-free survival approaching 9 months, demonstrating the drug’s effectiveness in broader patient populations.

A panelist discusses how combination studies like ELEVATE are exploring elacestrant with other targeted therapies, showing promising results with ribociclib and everolimus combinations that are well-tolerated and efficacious.

A panelist discusses how the EMBER-3 study results cannot be directly compared to those from EMERALD because of different patient populations, with EMBER-3 having fewer heavily pretreated patients and different baseline characteristics.

A panelist discusses how clinicians should exhaust all endocrine therapies plus targeted therapies before moving to chemotherapy or antibody-drug conjugates, while noting that different oral SERDs have varying adverse effect profiles that patients should be counseled about.