The Impact of Oral SERDs on the Changing Treatment Landscape

Oral SERDs are revolutionizing breast cancer treatment following progression on CDK4/6 inhibitors. Elacestrant received approval in January 2023 as a single agent for patients with ESR1-mutant tumors based on findings from the EMERALD study demonstrating improved progression-free survival compared with physician’s choice of endocrine therapy. The drug shows particular benefit in patients who remained on their prior CDK4/6 inhibitor for at least one year, serving as a marker of endocrine sensitivity.

Additional oral SERDs await regulatory approval, including imlunestrant from the Ember-3 trial results and camizestrant based on Serena-6 data. These agents are also being evaluated in early-stage clinical trials, indicating the expanding role of oral SERDs across different treatment settings. The development represents a significant advancement in targeted therapy options for hormone receptor–positive breast cancer patients.

The evolving landscape of oral SERDs promises to transform treatment sequencing and patient outcomes in metastatic breast cancer. As these agents move through regulatory approval processes, oncologists anticipate having multiple oral SERD options to personalize treatment based on individual patient characteristics and tumor biology. This expansion of therapeutic options represents a major step forward in precision oncology for patients with breast cancer with ESR1 mutations.