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O ponto de ligação do domínio de ligação ESR1 Y537S ou D538G — os dois pontos de ligação dominantes (~70% do total de ...

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IDRF-BREAST-ESR1-Y537S-D538G-CANDIDATE
TipoSinal de alerta
Estadorevisto 2026-04-29
DoençasDIS-BREAST
FontesSRC-EMERALD-BIDARD-2022 SRC-ESMO-BREAST-METASTATIC-2024 SRC-NCCN-BREAST-2025

Origem da bandeira vermelha

DefiniçãoESR1 ligand-binding-domain hotspot Y537S or D538G — the two dominant hotspots (~70% of all ESR1-LBD mutations) acquired in HR+/HER2- metastatic breast progressing on aromatase inhibitor. EMERALD (Bidard 2022) randomized post-AI ± CDK4/6i HR+ MBC to elacestrant vs endocrine standard-of-care; PFS benefit was concentrated in the ESR1-mutant subgroup (mPFS 3.8 vs 1.9 mo, HR 0.55). Y537S is associated with more aggressive biology than D538G in some series. Candidate RF refines RF-BREAST-ESR1-MUT-ACTIONABLE for the predominant hotspots specifically targeted by elacestrant data.
Direcção clínicaintensificar
Categoriahigh-risk-biology

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "esr1_y537s",
      "value": true
    },
    {
      "finding": "esr1_d538g",
      "value": true
    },
    {
      "finding": "esr1_hotspot",
      "value": "Y537S"
    },
    {
      "finding": "esr1_hotspot",
      "value": "D538G"
    },
    {
      "finding": "esr1_mutation",
      "value": "Y537S"
    },
    {
      "finding": "esr1_mutation",
      "value": "D538G"
    }
  ],
  "type": "biomarker"
}

Notas

Hotspot-specific narrowing of RF-BREAST-ESR1-MUT-ACTIONABLE. Y537S + D538G together account for ~70% of LBD mutations and are the hotspots most consistently represented in EMERALD subgroup analyses. Test on ctDNA at progression on AI ± CDK4/6i — preferred specimen due to subclonal + polyclonal nature of ESR1 mutations in tissue. Priority 67 sits between the broad ESR1-MUT-ACTIONABLE (70) and the AKT/PIK3CA family (65) — the engine should fire both this hotspot RF and the broader ESR1 RF when applicable; conflict resolution defers to clinical_direction (both intensify, no conflict). When ESR1-WT post-AI: elacestrant did not show benefit; switch to fulvestrant + capivasertib / alpelisib if PIK3CA / AKT1 / PTEN altered. EMERALD trial Source ingested (SRC-EMERALD-BIDARD-2022).

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