Oncology Today with Dr Neil Love Metastatic Breast Cancer — Optimizing the Use of Oral Selective Estrogen Receptor Degraders: Part 2
7 snips
Nov 29, 2025 
Dr. Rinath M Jeselsohn, a specialist in endocrine therapy resistance at Dana-Farber, and Dr. Joyce O’Shaughnessy, known for her expertise in breast cancer trials, dive into the latest in metastatic breast cancer treatments. They discuss the efficacy of oral selective estrogen receptor degraders, the importance of ctDNA testing for ESR1 mutations, and choices for therapy post-CDK4/6 progression. Insights into combination therapies and recent trial results illuminate the complexities of treatment strategies, providing a comprehensive overview for clinicians.
AI Snips
Chapters
Transcript
Episode notes
ESR1 Mutations Arise After AI Exposure
- ESR1 mutations are acquired in metastatic disease, especially after aromatase inhibitor exposure, and often indicate retained ER dependency.
- These mutations are common post-CDK4/6 plus AI and guide use of oral SERDs like elacestrant or imlunestrant.
Choose SERD Monotherapy For Endocrine‑Sensitive Disease
- Use oral SERD monotherapy (elacestrant or imlunestrant) for ESR1-mutant patients who show prior endocrine sensitivity, especially after durable benefit from CDK4/6 plus endocrine therapy.
- Consider clinical features (visceral disease, symptom burden, PIK3CA status) when choosing single-agent SERD versus combination therapy.
Target PIK3CA With Pathway‑Directed Therapies
- For PIK3CA-mutant patients, consider targeted PI3K/AKT pathway inhibitors (alpelisib or capivasertib) often combined with endocrine therapy.
- Balance efficacy with tolerability and patient comorbidities when selecting PI3K/AKT agents.