Oral SERDs in HR Positive Breast Cancer: Current Role and Patient Selection for Elacestrant

This segment defines the contemporary role of oral selective estrogen receptor degraders in HR positive HER2 negative metastatic breast cancer and clarifies which patients are most appropriate for elacestrant under current regulatory guidance. Panelists emphasize that oral SERDs have become a targeted endocrine option for patients whose tumors harbor ESR1 mutations that emerge after prior endocrine therapy. Clinical evidence discussed in the transcript indicates the greatest benefit occurs in patients who remain endocrine sensitive and who have progressed after a period of prior endocrine plus CDK4/6 inhibitor exposure, particularly when that prior line of therapy extended for roughly 12 months or longer. Practical selection therefore centers on timely molecular profiling using circulating tumor DNA or tissue testing to identify ESR1 alterations, assessment of prior endocrine responsiveness, and consideration of competing comorbidities or toxicity concerns. The conversation frames elacestrant as a biomarker directed therapy that should be offered when ESR1 mutation status and prior treatment history align with the indication.