FDA oncology advisers voted against using AstraZeneca’s oral SERD camizestrant in a new clinical setting proposed for patients with HR+/HER2− metastatic breast cancer. According to the ODAC panel vote, the committee found the evidence did not support a fundamental switch in treatment strategy based on ESR1 mutations detected in circulating tumor DNA, rather than waiting for radiographic progression. The decision highlights continued sensitivity in oncology to trial design and clinical end points when adopting ctDNA-guided treatment selection, even as ESR1 mutation testing becomes more widely used in practice.