From Podium To Practice
Drs. Wassim Mchayleh and Neil Iyengar examine the SERENA-6 trial and its potential to shift ER-positive metastatic breast cancer care from treatment changes based on radiographic progression to earlier intervention at molecular progression. They review the trial’s innovative design, the challenges of interpreting progression-free survival because of lead time bias, and why overall survival may be difficult to assess in a rapidly evolving treatment landscape. The discussion also highlights the clinical relevance of emergent ESR1 mutations, quality-of-life improvements, and the need to individualize decisions based on disease pace, symptoms, and patient preferences. Overall, they frame SERENA-6 as an important and controversial step toward more precise, ctDNA-guided endocrine therapy sequencing.
Contributors:
Dr. Wassim Mchayleh is Medical Director of Breast Oncology at Advent Health.
Dr. Neil Iyengar is Co-Director of Breast Oncology at Emory University School of Medicine.