Hotly anticipated late-stage data for Pfizer and Arvinas' oral oestrogen receptor-degrader vepdegestrant (ARV-471) debuted on Tuesday, with positive results seen in breast cancer patients with an ESR1 mutation. However, the drug failed to demonstrate benefit in those without the mutation, sending Arvinas shares down as much as 50%.While a number of oral selective oestrogen receptor degraders (SERDs) have delivered similarly mixed data — such as Menarini's Orserdu (elacestrant) and Eli Lilly's imlunestrant — hopes were high for vepdegestrant in the broader population. UBS analysts recently said "we think the potential for success in ESR1 [wild type] patients is greater than appreciated" for vepdegestrant, partially due to the design of the VERITAC-2 study.The trial enrolled 624 patients with oestrogen receptor-positive, HER2-negative advanced or metastatic breast cancer whose disease progressed following prior treatment with CDK 4/6 inhibitors and endocrine therapy. Participants were randomised to receive once-daily vepdegestrant or fulvestrant.PFS exceeded targetTop-line results showed that in patients with an ESR1 mutation, vepdegestrant demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) compared to fulvestrant, meeting the trial's primary endpoint in this population. Pfizer and Arvinas noted that PFS exceeded the pre-specified target hazard ratio of 0.60 in this group.However, the companies said that in the wider trial population, which also included those with ESR1 wild type, the study failed to reach statistical significance on improvement in PFS.OS data immaturePfizer and Arvinas noted that less than a quarter of the required number of events have occurred for the overall survival (OS) analysis — a key secondary endpoint — with the study continuing in order to evaluate this goal."The first Phase III data readout for a PROTAC degrader represents a significant achievement and these data show that vepdegestrant has the potential to provide clinically meaningful outcomes for…patients with metastatic breast cancer whose tumours harbour [ESR1] mutations," remarked John Houston, CEO at Arvinas. The companies noted that the data will be shared with global regulatory authorities, and presented at a medical conference later this year. Meanwhile, the Phase III VERITAC-3 study investigating vepdegestrant in combination with Pfizer's CDK 4/6 inhibitor Ibrance (palbociclib) in the first-line setting is also ongoing.Back in 2021, Pfizer paid $650 million upfront for rights to co-develop vepdegestrant, which utilises Arvinas' PROTAC (PROteolysis TArgeting Chimera) protein degrader platform.The VERITAC-2 results Tuesday follow a positive Phase III readout for AstraZeneca's oral SERD candidate camizestrant last month, showing a significant PFS benefit when paired with a CDK4/6 inhibitor in first-line patients with HR+/HER2- advanced breast cancer whose tumours have an emergent ESR1 mutation. In a recent interview with FirstWord to discuss the SERENA-6 study, key opinion leader Azka Ali described the results as a win-win for both safety and efficacy, and would likely hasten the shift from aromatase inhibitors to oral SERDs in patients with ESR1 mutations. For the rest of that conversation, see – KOL Views Q&A: Battle for oral SERD supremacy in HR+ breast cancer boils down to efficacy.