Dr. Hamilton on the EMERALD Trial in ER-Positive/HER2-Negative Breast Cancer

Erika P. Hamilton, MD, director, Breast Cancer and Gynecologic Cancer Research Program, principal investigator, Sarah Cannon Research Institute, discusses the updated analysis of the phase 3 EMERALD trial (NCT03778931) in estrogen receptor (ER)–positive, HER2-negative breast cancer.

The international, multicenter, randomized, open-label trial is evaluating the efficacy of the oral selective estrogen receptor degrader (SERD), elacestrant, vs standard-of-care endocrine therapy in patients whose breast cancer has advanced on no less than 1 endocrine therapy. An updated analysis of the phase 3 trial was presented at the 2022 ASCO Annual Meeting.

The excitement with SERDs remains, as the compounds continue to show benefit, Hamilton says. Moreover, these agents continue to work after fulvestrant, as well as work better than fulvestrant, Hamilton adds. However, predicting which patients may be endocrine sensitive remains important, Hamilton says. After endocrine therapy and CDK4/6 inhibitors in the first line, some patients may not have endocrine-sensitive tumors anymore, which can be seen in the top of the EMERALD PFS curve, Hamilton explains.

When examining patients who are endocrine sensitive and are gaining benefit from endocrine therapy, elacestrant appears superior, Hamilton continues. The next step should be attempting to utilize an assay or a genomic profile that canindicate which patients are estrogen sensitive and will gain benefit from these therapies, Hamilton concludes.