Developing Story: Beyond Camizestrant — The Evolving Landscape of ER+/HER2- MBC with Dr. Sarah Premji
Listen to full episode :
Live from Stage 4 | Episode #033| 06/16/2026 | Developing Story
GUESTS
Dr. Sarah Premji, MD, is a board-certified medical oncologist specializing in breast oncology. She serves as the Assistant Director of Breast Cancer Research at the Sarah Cannon Research Institute (SCRI) and practices clinically at SCRI Oncology Partners in Nashville, Tennessee.
🎓 Education & Training
Undergraduate Degree: B.S. in Biology and B.S. in Psychology from the University of Georgia.
Medical Degree: M.D. from the Medical College of Georgia.
Residency: Internal Medicine at the Baylor College of Medicine in Houston, Texas.
Fellowship: Hematology and Oncology at the Mayo Clinic in Rochester, Minnesota.
🏥 Current Roles & Clinical Focus
Research Leadership: Appointed as Assistant Director of Breast Cancer Research in late 2025 to lead operations across SCRI’s clinical trials network.
Clinical Practice: Works as a medical oncologist at SCRI Oncology Partners treating breast cancer patients.
Specialized Expertise: Focuses on biology-driven, personalized oncology care, liquid biopsies (ctDNA), and minimizing treatment toxicity for individual patient needs.
🏆 Awards & Professional Impact
ASCO Award: Recipient of the prestigious 2025 ASCO Conquer Cancer Young Investigator Award.
Board Certifications: Triple board-certified by the American Board of Internal Medicine in Internal Medicine, Hematology, and Medical Oncology.
Industry Contributor: Serves as an expert commentator and presenter at major conferences like the American Society of Clinical Oncology (ASCO).
Quick Summary
In this episode of Life from Stage IV, hosts Victoria Goldberg and Abigail Johnston sit down with Dr. Sarah Premji, breast cancer oncologist at Sarah Cannon, to explore the rapidly evolving treatment landscape for HR-positive, HER2-negative metastatic breast cancer. From the new generation of oral SERDs to emerging mechanisms like PROTACs and CERANs, this conversation goes beyond the headlines to help clinicians and patients understand what the latest approvals and data mean in practice.
Key Takeaways
CDK4/6 inhibitors combined with aromatase inhibitors remain the standard first-line backbone for HR+/HER2- MBC, and patients live longer on this combination.
ESR1 mutations are a critical resistance mechanism to track. Liquid biopsy at progression is now standard practice and directly informs which second-line agent to use.
The oral SERD era is here. Elacestrant, imlunestrant, and vepdegestrant are all FDA-approved for ESR1-mutated MBC, each with a distinct mechanism and tolerability profile.
Vepdegestrant (a PROTAC) works differently from SERDs. It tags the estrogen receptor for destruction via the cell's own proteasome pathway and recycles itself, making it more potent at receptor degradation.
Imlunestrant combined with a CDK4/6 inhibitor nearly doubled progression-free survival in ESR1-mutated patients, raising serious questions about whether SERD plus targeted agent should become the new second-line standard.
The treatment algorithm is highly individualized. Tumor profiling, duration of prior therapy, sites of disease, comorbidities, and patient lifestyle all factor into sequencing decisions.
Lobular and ductal breast cancers behave differently in the hormone-positive space and may warrant distinct treatment considerations.
AI is entering oncology in meaningful ways, including clinical trial matching, pathology support, and imaging analysis, with the goal of making providers more efficient without replacing the patient-physician relationship.
The field is optimistic. Multiple mechanisms are being studied across lines of therapy and in combination, and investigators believe the right questions are being asked and actively addressed.
