Future Uses of Elacestrant in Metastatic/Early-Stage Breast Cancer

Data from the phase 3 EMERALD trial (NCT03778931) indicated that elacestrant (Orserdu) appeared to yield significant PFS benefit vs standard-of-care endocrine therapy in ER-positive/HER2-negative metastatic breast cancer, and warrants further investigation, according to Janice Lu, MD, PhD at the 2023 San Antonio Breast Cancer Symposium (SABCS).¹

In a conversation with CancerNetwork®, Lu, professor and director of Breast Medical Oncology at Northwestern University Lurie Comprehensive Cancer Center, discussed the possible future for elacestrant as a monotherapy or in combination with other therapies in metastatic and early-stage breast cancer.

Transcript:

The subgroup analysis of elacestrant presented at the 2023 SABCS, in my opinion, is quite impressive. Elacestrant is now being investigated in several clinical trials alone or in combination with other therapies, both in metastatic and in early-stage breast cancer. There are 2 abstracts [that were] presented: One is the phase 1b/2 ELEVATE trial [NCT05563220],² and the other one is the phase 1b/2 ELECTRA trial [NCT05386108].³

ELEVATE is an ongoing open-label umbrella study evaluating elacestrant in various combinations in the metastatic setting, [including] alpelisib [Piqray], everolimus [Afinitor], palbociclib [Ibrance], abemaciclib [Verzenio], or ribociclib [Kisqali]. The ELECTRA trial is a study of abemaciclib and elacestrant in patients with brain metastases. At my institution, the Northwestern University Lurie Comprehensive Cancer Center, [there is] a study using single-agent elacestrant vs elacestrant in combination of CDK 4/6 inhibitor with prior exposure to a different CDK. Other trials are in development that will potentially move elacestrant to the first-line space and possibly in the adjuvant setting as well.

References

1. Bardia A, Bidard FC, Neven P, et al. Elacestrant vs standard-of-care in ER+/HER2- advanced or metastatic breast cancer (mBC) with ESR1 mutation: key biomarkers and clinical subgroup analyses from the phase 3 EMERALD trial​. Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX. Poster PS17-02.
2. Rugo H, Bardia A, Cortés J, et al. ELEVATE: A phase 1b/2, open-label, umbrella study evaluating elacestrant in various combinations in patients (pts) with estrogen receptor-positive (ER+), HER2-negative (HER2-) locally advanced or metastatic breast cancer (mBC)​. Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX. Poster PO2-05-04.
3. Ibrahim N, Kim S, Lin N, et al. ELECTRA: An open-label, multicenter, phase 1b/2 study of elacestrant in combination with abemaciclib in patients with brain metastasis (mets) from estrogen receptor-positive (ER+), HER2-negative (HER2-) breast cancer (BC). Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX. Poster PO2-05-05.