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Peer-reviewedCC BYThe oncologist

Integrating ctDNA-based ESR1m monitoring into first-line care for ER+, HER2- advanced breast cancer: a consensus workflow.

  • Yara Abdou1
  • Amber Cipriani2,3
  • Trevor Feinstein4
  • Ryan Haumschild5
  • Mabel Mardones6,7
  • Joanne Mortimer8
  • Eric Vail9
9 affiliations
  1. 1Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
  2. 2Department of Pharmacy, UNC Health Medical Center, Chapel Hill, NC 27514, United States.
  3. 3UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
  4. 4Piedmont Cancer Institute, Fayetteville, GA 30214, United States.
  5. 5Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States.
  6. 6Sarah Cannon Research Institute, Denver, CO 80218, United States.
  7. 7Rocky Mountain Cancer Centers, Aurora, CO 80012, United States.
  8. 8Duarte Cancer Center, Duarte, CA 91010, United States.
  9. 9Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
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Abstract

Circulating tumor DNA (ctDNA) is an emerging tool in precision oncology that enables noninvasive tumor profiling, detection of minimal residual disease, and treatment monitoring. Furthermore, routine ctDNA analyses offer the potential to support more personalized and dynamic cancer care. In advanced breast cancer (aBC), ctDNA-based monitoring has been investigated across multiple studies as a tool for detecting emerging resistance mechanisms, predicting treatment responses and informing biomarker-guided treatment decisions. One example, investigated in the phase III PADA-1 and SERENA-6 trials, is monitoring for emergent estrogen receptor alpha mutations (ESR1m) during first-line endocrine therapy in estrogen-receptor positive, human epidermal growth factor receptor 2-negative (ER+, HER2-) aBC. While not yet widely adopted in clinical practice, broader implementation of routine ctDNA-based monitoring for ESR1m is anticipated and will require standardized diagnostic workflows, encompassing both institutional operational processes and patient-centered scheduling pathways. Insights and recommendations were gathered from multidisciplinary experts across academic and community practices in the United States regarding the feasibility, barriers, and operational requirements for implementing ESR1m monitoring during first-line treatment of aBC. Here, we present practical, experience-informed considerations, supplemented by an opinion-based consensus workflow model designed to provide clinicians with a flexible framework for implementing ctDNA-based ESR1m monitoring during first-line care for ER+, HER2- aBC.

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Cite

BibTeXRIS
BibTeX
@article{abdou2026integrating,
  title = {{Integrating ctDNA-based ESR1m monitoring into first-line care for ER+, HER2- advanced breast cancer: a consensus workflow.}},
  author = {Yara Abdou and Amber Cipriani and Trevor Feinstein and Ryan Haumschild and Mabel Mardones and Joanne Mortimer and Eric Vail},
  journal = {The oncologist},
  year = {2026},
  month = oct,
  doi = {10.1093/oncolo/oyag411},
  url = {https://europepmc.org/article/MED/42885553},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Integrating ctDNA-based ESR1m monitoring into first-line care for ER+, HER2- advanced breast cancer: a consensus workflow.
AU  - Yara Abdou
AU  - Amber Cipriani
AU  - Trevor Feinstein
AU  - Ryan Haumschild
AU  - Mabel Mardones
AU  - Joanne Mortimer
AU  - Eric Vail
PY  - 2026
DA  - 2026/10/01
JO  - The oncologist
DO  - 10.1093/oncolo/oyag411
UR  - https://europepmc.org/article/MED/42885553
AB  - Circulating tumor DNA (ctDNA) is an emerging tool in precision oncology that enables noninvasive tumor profiling, detection of minimal residual disease, and treatment monitoring. Furthermore, routine ctDNA analyses offer the potential to support more personalized and dynamic cancer care. In advanced breast cancer (aBC), ctDNA-based monitoring has been investigated across multiple studies as a tool for detecting emerging resistance mechanisms, predicting treatment responses and informing biomarker-guided treatment decisions. One example, investigated in the phase III PADA-1 and SERENA-6 trials, is monitoring for emergent estrogen receptor alpha mutations (ESR1m) during first-line endocrine therapy in estrogen-receptor positive, human epidermal growth factor receptor 2-negative (ER+, HER2-) aBC. While not yet widely adopted in clinical practice, broader implementation of routine ctDNA-based monitoring for ESR1m is anticipated and will require standardized diagnostic workflows, encompassing both institutional operational processes and patient-centered scheduling pathways. Insights and recommendations were gathered from multidisciplinary experts across academic and community practices in the United States regarding the feasibility, barriers, and operational requirements for implementing ESR1m monitoring during first-line treatment of aBC. Here, we present practical, experience-informed considerations, supplemented by an opinion-based consensus workflow model designed to provide clinicians with a flexible framework for implementing ctDNA-based ESR1m monitoring during first-line care for ER+, HER2- aBC.
SN  - 1083-7159
SN  - 1549-490X
ER  -