Oral SERDs and Discussing ctDNA Results With Patients

Rebecca Shatsky, MD, describes discussing ESR1 mutation results with patients, walking them through ctDNA clonal expansion data on a Guardant360 report and explaining why treatment needs to change before disease progresses. She reviews the oral selective estrogen receptor degrader landscape: elacestrant and imlunestrant are FDA approved, camizestrant is approved in Europe under the SERENA-6 strategy but not yet in the United States, and giredestrant and palazestrant remain in clinical trials. Carol Tweed, MD, adds that detecting an ESR1 mutation in a radiographically stable patient still gives meaningful information, since it signals progression is likely within months rather than years. She describes this as giving patients a gift of planning time, allowing life decisions and closer symptom monitoring before a scan shows change, and says she now favors changing therapy once that molecular signal appears.