{"entity":{"id":"paper-emerald-elacestrant-jco-2022","kind":"paper","name":"EMERALD: elacestrant versus standard endocrine therapy after a CDK4/6 inhibitor","aka":[],"tldr":"The oral oestrogen receptor degrader elacestrant delayed progression compared with standard hormone therapy in advanced breast cancer that had progressed on a CDK4/6 inhibitor, with the clearest benefit in tumours carrying an ESR1 mutation.","summary":"Phase 3 trial of 477 patients with oestrogen receptor-positive, HER2-negative advanced breast cancer previously treated with one or two lines of endocrine therapy including a CDK4/6 inhibitor, randomised to elacestrant or investigator's choice of fulvestrant or an aromatase inhibitor.\n\nProgression-free survival was improved overall (hazard ratio 0.70) and in the ESR1-mutated group (hazard ratio 0.55), where median progression-free survival was 3.8 versus 1.9 months; benefit was largest in patients with longer prior CDK4/6 inhibitor exposure.","asOf":"2026-09-17","links":[{"label":"J Clin Oncol 2022","url":"https://doi.org/10.1200/JCO.22.00338"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/35584336/"}],"tags":[],"related":[],"cancers":["hr-positive-metastatic-post-cdk46"],"sections":[],"technologies":[],"targets":[],"drugs":["elacestrant"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["emerald"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2022,"doi":"10.1200/JCO.22.00338","pmid":"35584336","authors":"Bidard FC, Kaklamani VG, Neven P, et al.","paperType":"rct","findings":["Progression-free survival hazard ratio 0.70 overall and 0.55 in ESR1-mutated disease.","Median progression-free survival 3.8 vs 1.9 months in ESR1-mutated tumours."],"whatItMeans":"Elacestrant is the first oral selective oestrogen receptor degrader approved, for ESR1-mutated disease after a CDK4/6 inhibitor. Absolute gains are modest and blood testing for ESR1 mutations is now routine at progression.","caveats":["Absolute benefit is small and control-arm performance was poor.","Nausea and lipid changes are common."],"changedPractice":true,"participants":477},"route":"/key-papers/paper-emerald-elacestrant-jco-2022/","neighbours":{"cancer":[{"id":"hr-positive-metastatic-post-cdk46","kind":"cancer","name":"HR-positive metastatic breast cancer after CDK4/6 inhibitors","route":"/cancers/hr-positive-metastatic-post-cdk46/"}],"drug":[{"id":"elacestrant","kind":"drug","name":"Elacestrant","route":"/drugs/elacestrant/"}],"trial":[{"id":"emerald","kind":"trial","name":"EMERALD","route":"/trials/emerald/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}