In this clinical topic video, Professor of Medicine Dr Virginia Kaklamani shares her insights on the recent publication of the subgroup analyses from the phase III EMERALD Trial by prior duration of endocrine therapy plus CDK4/6 inhibitor.

Dr Kaklamani highlights elacestrant's place in the treatment landscape for ER+/HER2- metastatic breast cancer. 

Clinical takeaways

• Elacestrant provides a PFS benefit for patients with ER+/HER2- mBC who received at least 12 months of ET+CDK4/6i in 1st line and whose tumours harbour ESR1-mut with a favourable safety profile
• ESR1-mut testing should be done at 1st line progression via liquid biopsy due to disease subclonality; if negative, repeat at each progression. Archival tissue should not be used for testing due to the acquired nature of ESR1-mut
• Elacestrant provides significant PFS benefits in ER+/HER2- metastatic tumours harbouring coexisting ESR1 and PIK3CA-mut, indicating that disease progression after ET+CDK4/6i in this subgroup may remain ER-driven. Safety analyses demonstrated that elacestrant had a manageable safety profile similar to other ETs