Elacestrant for ER-positive, HER2-negative, locally advanced or metastatic breast cancer with an activating ESR1 mutation

Published on 01 Jul 2026
Last Updated on 01 Jul 2026

Guidance Recommendations

The Ministry of Health’s Drug Advisory Committee has not recommended elacestrant for inclusion on the MOH List of Subsidised Drugs for ER-positive, HER2-negative, locally advanced or metastatic breast cancer with an activating ESR1 mutation following disease progression after at least 12 months of endocrine therapy plus cyclin-dependent kinase 4/6 inhibitor (CDK4/6i). The decision was based on the uncertain extent of clinical benefit compared with fulvestrant monotherapy, unfavourable cost effectiveness compared with alternative treatments, and the unacceptable price-volume agreement proposed by the company. 

Clinical indication, subsidy class and MediShield Life claims eligibility for elacestrant are provided in the Annex. 

Elacestrant for ER-positive, HER2-negative, locally advanced or metastatic breast cancer with an activating ESR1 mutation (Published 1 July 2026) [PDF, 309.63 KB]

Plain English Summary

Breast cancer occurs when abnormal cells grow uncontrollably in the ducts or lobules of the breast and spread into the surrounding breast tissue. When the cancer spreads to nearby areas, this is known as locally advanced disease. When it spreads to other parts of the body, this is known as advanced or metastatic disease.

Breast cancers are classified based on certain proteins (receptors) found on cancer cells. ER (oestrogen receptor)-positive cancers have receptors that bind to oestrogen, which can help the cancer grow. HER2 (human epidermal growth factor receptor 2)-negative cancers have low levels of HER2 protein on the surface of the cells. Some cancers develop changes (mutations) in the oestrogen receptor 1 (ESR1) gene which can make them less responsive to standard hormone therapies.

Elacestrant is a type of hormone therapy known as a selective oestrogen receptor degrader (SERD). It works by blocking and breaking down oestrogen receptors, helping to slow or stop the growth of cancer cells. It is taken orally.

Elacestrant was not recommended for government funding because its benefits do not justify its cost compared with alternative treatments. It is not subsidised and cannot be claimed under MediShield Life.

There are different treatments available for advanced breast cancer. Your doctor can advise whether elacestrant or other treatments may be suitable for you.