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Exploring a Patient Case: Biomarker Testing After Progression and Discussing Treatment Choices With Your Care Team

Panelists discuss how to communicate genomic testing results to patients and make shared treatment decisions, particularly when multiple targeted therapy options are available for patients with ESR1 and PIK3CA mutations.

Clinical Brief: EMERALD Trial Insights for ESR1-Mutant Breast Cancer

Main Discussion Topics:

  • Overview of EMERALD trial design and patient population
  • Co-primary end points and efficacy outcomes for ESR1-mutant tumors
  • Critical subset analyses identifying best responders (>12 months prior CDK4/6)
  • Median PFS outcomes: 8.6 months versus 3.8 months in optimal patients
  • Limited relevance of variant allele frequency (VAF) for treatment selection

Key Points for Physicians:

  • Elacestrant approved specifically for ESR1-mutant metastatic breast cancer
  • Prior CDK4/6 duration greater than 12 months predicts better response (8.6 versus 1.9 months PFS)
  • Benefit maintained across visceral disease, multiple metastatic sites
  • PIK3CA co-mutations do not negate elacestrant benefit
  • VAF is not currently useful for treatment selection decision-making

The EMERALD trial established that patient selection based on endocrine sensitivity duration, rather than just mutation presence, optimizes treatment outcomes with elacestrant.

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