An Introduction to ER+/HER2- mBC and Current Treatment Options
Aditya Bardia, MD, MPH briefly explains metastatic ER+/HER2- breast cancer, and reviews existing treatment options for patients with ER+/HER2- mBC.
Dr. Aditya Bardia: Hello. I'm Aditya Bardia, a breast medical oncologist at Massachusetts General Hospital, Harvard Medical School, Boston.
Today, we'll review potential role of Elacestrant for the treatment of metastatic ER-positive HER2-negative breast cancer. We'll start with an overview of metastatic ER-positive breast cancer, the current landscape, and then review the EMERALD trial with I Elacestrant for metastatic ER-positive breast cancer.
Metastatic ER-positive HER2-negative breast cancer represents a subset of metastatic disease. Metastatic disease refers to patients who have evidence of breast cancer outside of the breast in the bones, liver, or other organs. ER-positive refers to tumors that express estrogen receptors and do not have HER2 amplification so therefore HER2-negative. In general, tissue biopsy is the mainstay for diagnosis of metastatic ER-positive HER2-negative breast cancer. It helps with confirmation of the diagnosis and also evaluation of the receptors.
Endocrine-based therapy is the mainstay of management of metastatic ER-positive HER2-negative breast cancer. It's also the mainstay of management for early ER-positive HER2-negative breast cancer. For metastatic ER-positive HER2-negative metastatic breast cancer, the first line of therapy includes endocrine therapy with a CDK4/6 inhibitor. Usually, it's aromatase inhibitor, but in specific situations fulvestrant is used as the first line endocrine therapy in combination with a CDK4/6 inhibitor. Options for CDK4/6 inhibitors include ribociclib, abemaciclib, and palbociclib. We've seen improvement in overall survival with the use of endocrine therapy plus abema, endocrine therapy plus ribociclib in the first-line setting.
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