HR-Positive Breast Cancer: Testing Strategies, Frequency, and System-Level Considerations for ESR1 Monitoring

This segment explores practical considerations for implementing ESR1 mutation testing in hormone receptor–positive, HER2-negative metastatic breast cancer, with a focus on testing strategy, frequency, and system-level constraints. Dr. Adam Brufsky raises key questions around when to initiate testing, how often to repeat it, and whether institutional policies will guide adoption in clinical practice.

Dr. Hope S. Rugo discusses the potential shift toward more targeted testing approaches, suggesting that focused ESR1 assays may be more practical than repeated broad next-generation sequencing panels. Dr. Lisa Raff highlights payer considerations, emphasizing the importance of aligning testing strategies with clinical trial design and guideline recommendations to support reimbursement.

Ms. Lori Brisbin adds that targeted assays may offer advantages in turnaround time, cost, and sensitivity, while also noting variability across testing platforms. Overall, this segment underscores the need to balance clinical utility with feasibility, cost, and system capacity when integrating ESR1 monitoring into routine care.