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SABCS 2025 | ERADICATE: elacestrant plus trastuzumab deruxtecan in HR+/HER2-low mBC

Sarah L. Sammons, MD, Dana-Farber Cancer Institute, Boston, MA, discusses the ERADICATE trial (NCT07198724), a Phase Ib/II study evaluating elacestrant plus trastuzumab deruxtecan in patients with CDK4/6 inhibitor and endocrine-resistant hormone receptor-positive/HER2-low or HER2-ultralow metastatic breast cancer. The trial is based on preclinical data demonstrating that selective estrogen receptor degraders (SERDs) synergize with chemotherapy agents including 5-FU, taxanes, and doxorubicin. The study represents the first combination of a SERD with trastuzumab deruxtecan, evaluating both safety and preliminary efficacy in a first-line chemotherapy population with prior endocrine therapy but no prior chemotherapy. Enrollment requires ER-positive/HER2-low or HER2-ultralow measurable disease, with equal representation of ESR1-mutant (50%) and ESR1 wild-type (50%) patients. Given both agents’ brain activity, patients with stable or asymptomatic small untreated brain metastases are eligible. This interview took place at the San Antonio Breast Cancer Symposium (SABCS) 2025 Meeting in San Antonio, TX.

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Transcript

So at this San Antonio, we’re presenting our trials in progress for the ERADICATE clinical trial that is being run by myself, Dr Sarah Sammons, and co-PI Rinath Jeselsohn from Dana-Farber. And it’s really based on Dr Jeselsohn’s preclinical data that selective estrogen receptor degraders can actually synergize with chemotherapy and preclinical models. So she showed that there is an additive benefit of SERDs and chemotherapy, and she used preclinical models looking at 5-FU chemotherapy, taxane, doxorubicin, and there seemed to be a synergistic effect...

So at this San Antonio, we’re presenting our trials in progress for the ERADICATE clinical trial that is being run by myself, Dr Sarah Sammons, and co-PI Rinath Jeselsohn from Dana-Farber. And it’s really based on Dr Jeselsohn’s preclinical data that selective estrogen receptor degraders can actually synergize with chemotherapy and preclinical models. So she showed that there is an additive benefit of SERDs and chemotherapy, and she used preclinical models looking at 5-FU chemotherapy, taxane, doxorubicin, and there seemed to be a synergistic effect. So based on this data, we are for the first time combining the SERD, elacestrant, with trastuzumab deruxtecan to look at not only safety for the first time, but also preliminary efficacy. Patients can be enrolled if they are ER positive, HER2 low or ultra low. We are only enrolling a first-line chemotherapy population so they can have prior endocrine therapy but no prior chemo. 50% will have ESR1 mutations, 50% will not. Patients have to have measurable disease. Because both agents have active activity in the brain, we are allowing stable brain metastasis patients and asymptomatic small untreated brain metastasis as well.

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