Research To Practice | Oncology Videos ER-Positive Metastatic Breast Cancer — A Roundtable Discussion on the Current and Future Role of Oral SERDs
Nov 14, 2025
Dr. Rebecca Shatsky, an academic oncologist specializing in breast cancer, shares insights on biomarker testing for ER-positive metastatic cases. Prof. Francois-Clement Bidard discusses the novel applications of oral SERDs in treatment regimens. Dr. Seth Wander dives into data analyses surrounding oral SERD monotherapy and its integration with ctDNA monitoring. Dr. Hope Rugo emphasizes patient-centered care, reviewing tolerability and management strategies for oral SERDs, ensuring that clinical practices align with patient needs.
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ESR1 Mutations Emerge Over Time
- ESR1 mutations commonly arise as an acquired resistance to aromatase inhibitors and increase with lines of therapy.
- Test for ESR1 repeatedly over time, ideally with ctDNA, because single-site tissue biopsies can miss heterogeneity.
Prefer ctDNA And Re-test At Progression
- Use ctDNA (liquid biopsy) preferentially for NGS because it surveys multiple metastatic sites and increases mutation detection yield.
- Repeat molecular testing at each disease progression to capture newly acquired actionable alterations.
Oral SERDs Outperform Fulvestrant In ESR1+
- Oral SERDs have better bioavailability and ER affinity versus intramuscular fulvestrant and show activity in ESR1-mutant patients.
- EMERALD showed larger benefit in ESR1-mutant subgroups and after longer prior benefit on first-line AI+CDK.