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How do you approach treatment of patients with metastatic HR+ breast cancer with detection of ESR1 mutation after initiation of an AI and CDK4/6 Inhibitor?

How does data from PADA-1 and EMERALD trials impact your decision-making?
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How would you treat a patient with metastatic HR+ breast cancer with detection of ESR1 mutation after initiation of AI + CDK4/6i?

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3 Answers
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Medical Oncology · University of Pittsburgh School of Medicine
Answered on · Updated on

In PADA-1 (SABCS 2021), the development of an ESR1 mutation, regardless of progression on scans, followed by the continuation of palbociclib but changing to fulvestrant, was associated with a PFS of 11.9 m. If one waited until clinical progression, then treated with fulvestrant and palbociclib, the ...

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Mednet Member
Mednet Member
Medical Oncology · Levine Cancer Institute, Atrium Health
Answered on

For patients with metastatic hormone receptor-positive (HR+) breast cancer (MBC) who develop an ESR1 mutation (ESR1mut) after initiation of an aromatase inhibitor (AI) and CDK4/6 inhibitor, there are several factors to consider. It is important to understand the full spectrum of potential biomarkers...

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Mednet Member
Mednet MemberInvited Expert
Medical Oncology · Ohio State University
Answered on

Based on the results of the PADA-1 trial that showed longer composite progression free survival in patients who switched an aromatase inhibitor to fulvestrant upon detection of ESR1 mutation in the circulating tumor DNA (as compared to patients with detectable ESR1 mutation who waited until radiogra...

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