The SERENA-6 trial assessed a paradigm-shifting approach to personalized cancer therapy in patients with advanced-stage breast cancer, in which therapy was switched upon the identification of resistance-related mutations in ESR1 in circulating tumour DNA (ctDNA). Herein, we discuss how the results of this trial challenge the standard-of-care management for these patients, in whom therapy changes are otherwise undertaken only after radiographic and/or clinical progression.
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Acknowledgements
A.J.M. has received research support from the American Cancer Society (grant number IRG-21-130-10) and the National Institutes of Health (grant K12CA087723).
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A.J.M. has served as a paid advisor/consultant for AstraZeneca, Edgewood Oncology, Guardant Health, Illumina, Myriad Genetics, Natera, Novartis, Reversing Early Recurrence and Science for America, and has been a non-remunerated advisor/consultant for SAGA Diagnostics, all outside the submitted work. S.A.W. has received honoraria as an advisor/consultant for AstraZeneca, Biovica, Eli Lilly, Foundation Medicine, Genentech, Gilead, Hologic, Novartis, Pfizer/Arvinas, Puma Biotechnology, Regor Therapeutics, Stemline/Menarini and Veracyte, and as an educational speaker for 2ndMD, Eli Lilly and Guardant Health; and their institution receives research support from Eli Lilly, Genentech, Nuvation Bio, Pfizer/Arvinas, Phoenix Molecular Designs, Puma Biotechnology, Regor Therapeutics, Sermonix and Stemline/Menarini.
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Medford, A.J., Wander, S.A. SERENA-6: dynamic ctDNA assessment and the future of precision cancer medicine. Nat Rev Clin Oncol 22, 804–805 (2025). https://doi.org/10.1038/s41571-025-01066-2
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DOI: https://doi.org/10.1038/s41571-025-01066-2
