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Next Gen ET Key Takeaways
Next-Generation Endocrine Therapies for ER+/HER2- Breast Cancer Care: Key Takeaways From Our Recent Symposium in San Antonio

Released: December 20, 2023

Erika P. Hamilton
Erika P. Hamilton, MD
Kevin Kalinsky
Kevin Kalinsky, MD, MS
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This commentary includes a review of key clinical guidance from the satellite symposium “Next-Generation Endocrine Therapies: Opportunities in ER+/HER2- Breast Cancer Care” with Erika P. Hamilton, MD, and Kevin Kalinsky, MD, MS, conducted at SABCS 2023. For your convenience, the link below provides access to the program page containing the corresponding on-demand webcast recording of the symposium and downloadable slides.

Program Page

Key Takeaways from the live program include:

  • Mutation testing is key to treatment decisions for patients progressing on first-line endocrine therapy with or without a CDK4/6 inhibitor.
    • ESR1 mutations are rare in patients with recently diagnosed advanced disease who need first-line therapy but can occur at a frequency of 40% after first-line therapy.
    • Per ASCO guidelines, routine testing for ESR1 mutations should occur at recurrence or progression on endocrine therapy with or without a CDK4/6 inhibitor with blood-based circulating tumor DNA assays.
  • Better assays to define estrogen receptor resistance are needed to identify appropriate patients for further endocrine therapy.
  • The single-agent oral selective estrogen receptor degrader (SERD) elacestrant is approved for those with clinical benefit on a prior CDK4/6 inhibitor who harbor an ESR1 mutation.
    • Other oral SERDs—such as camizestrant, giredestrant, and imlunestrant—are on the horizon.
    • Other agents in development with different mechanisms of action include complete estrogen receptor antagonists (CERANs), proteolysis-targeting chimeras (PROTACs), and selective estrogen receptor modulators (SERMs).
  • How targeted agents (eg, alpelisib, capivasertib, inavolisib) will be combined with novel endocrine therapy remains to be determined.

Please be sure to access our Independent Conference Coverage here for slides and Expert Analyses of the most recent key findings presented at SABCS 2023, as selected by the experts!

Best,
The CCO Team