Elacestrant in metastatic breast cancer: current advancements and future perspectives

Hormone receptor-positive and HER2-negative advanced breast cancer is the most prevalent subtype and poses therapeutic challenges. While endocrine therapy remains the cornerstone of management, acquired resistance, particularly stemming from ESR1 mutations, limits long-term efficacy. Consequently, novel endocrine agents with enhanced potency, oral bioavailability, and favorable tolerability are crucial for overcoming resistance and improving patient outcomes.

This review provides a comprehensive evaluation of elacestrant, an orally active selective estrogen receptor degrader that has transformed the treatment paradigm for endocrine resistant disease. The pharmacologic properties, antitumor activity, and clinical outcomes associated with elacestrant are discussed in detail, along with ongoing research exploring its integration into combination regimens and in earlier disease settings.

Elacestrant has become an important therapeutic option for patients with ESR1-mutated disease, offering durable estrogen receptor suppression and favorable tolerability. Combination therapies targeting CDK4/6 and PI3K-AKT-TOR signaling pathways represent promising directions for extending endocrine sensitivity. With the growing integration of liquid biopsy technologies and molecular monitoring into clinical practice, dynamic treatment adaptation guided by real time molecular profiling is expected to refine therapy selection. Elacestrant is a benchmark in the shift toward individualized endocrine therapy in metastatic breast cancer, bridging molecular precision with clinical practicality.