7th September 2026 by Sarah Thomas Education
The Scottish Medicines Consortium (SMC) has accepted two new targeted therapies for NHS Scotland: Elacestrant (Korserdu®) and Capivasertib (Truqap®).
This decision represents a major milestone for our community, offering much-needed targeted options for people living with hormone receptor-positive, HER2-negative advanced breast cancer. However, we also know that today’s news comes with a reality that feels deeply bittersweet.
Both of these treatments are precision medicines. To receive them, patients must first have a genomic test to confirm that their cancer carries specific genetic mutations. Because routine NHS genomic testing pathways for these mutations are not yet fully established across all Scottish health boards, most patients cannot access these medicines on the NHS straight away.
Below, we break down what these approvals mean, why the testing bottleneck exists, and how to safely navigate your options.
Both treatments have been accepted by the SMC for specific groups of patients whose cancer has progressed following prior hormone-based therapies and CDK4/6 inhibitors:
Elacestrant: Approved for ER-positive, HER2-negative locally advanced or metastatic breast cancer whose tumours have an ESR1 mutation.
Capivasertib: Approved for HR-positive, HER2-negative locally advanced or metastatic breast cancer whose tumours have mutations in the PIK3CA, AKT1, or PTEN genes.
Because these drugs target specific growth pathways, they only work if your cancer cells carry the corresponding genetic mutation.
To check for ESR1, PIK3CA, AKT1, or PTEN mutations, doctors must analyse a fresh sample of your tumour - either through a specialised blood test (called a liquid biopsy) or a physical tissue biopsy.
While the SMC has approved the drugs independently, the NHS testing service required to identify these mutations is still being finalised. Work is urgently underway between clinicians, genomic networks, pharmaceutical companies and health boards to get these routine testing pathways up and running as quickly as possible.
Your first and most important step is to speak directly with your NHS oncology team.
Genomic testing is not necessary or appropriate for every stage or subtype of the disease. These treatments are specifically tailored for certain groups of patients. Your oncologist can help clarify:
Whether testing for ESR1, PIK3CA, AKT1, or PTEN is clinically appropriate for you at your current stage of treatment.
Whether any local NHS testing options or clinical access routes are already available in your specific health board.
What alternative, highly effective treatments are available to you right now while testing infrastructure is being completed.
Some patients consider private testing to find out their mutation status sooner. As a charity, we do not endorse or recommend specific private testing companies or laboratories. If you are considering paying for a private test, it is vital that you discuss this with your oncologist before spending any money.
Please keep these important factors in mind:
Your NHS team must accept the results: Not all NHS health boards can accept test results from private or unaccredited laboratories. Your oncologist needs to confirm in advance that they can use a private test result to guide your NHS care.
Timing matters: Mutations often develop after exposure to certain treatments. Testing too early or testing an old tissue sample from years ago may not give an accurate picture of your cancer today.
A positive test does not guarantee these treatments are right for you: Your oncologist will still need to assess whether these are the most effective choice compared to other available treatments.
You may pay out-of-pocket for the test and find out the mutations are not present, or there are other mutations that we don’t have targeted treatments for yet, which can take an emotional toll.
We know many members of our community are currently seeing targeted ads on social media and search engines for private cancer gene testing. While some private laboratories are reputable, others can be misleading, predatory, or extremely expensive.
Here are key tips to help you verify whether a private testing provider is legitimate:
Red Flags (What to Watch Out For)
Cheek swabs or saliva kits: ESR1, PIK3CA, AKT1, and PTEN mutations in this context are acquired mutations found inside tumour cells, not inherited genes you are born with. Any company claiming to test for these using a home cheek swab or saliva kit is invalid for this purpose.
No doctor involved: Legitimate clinical genomic tests almost always require an order or referral from a qualified healthcare professional. Avoid "direct-to-consumer" cancer tests sold without medical oversight.
Promises of "instant cures" or guaranteed drug matches: Reputable labs provide technical data to clinicians; they never promise guaranteed medical outcomes or sell “cure packages”.
Green Flags (What to Look For)
Official accreditation: Check that the laboratory holds formal medical accreditation. In the UK, look for UKAS accreditation (ISO 15189). International labs should hold equivalent standards, such as CLIA or CAP certification.
Transparent pricing and data protection: Legitimate labs state all costs upfront (including sample handling) and strictly comply with UK GDPR privacy standards regarding your genetic data.
Direct Coordination with the NHS: Reputable private providers usually send comprehensive technical reports directly to your NHS hospital doctor.
It is a monumental win that the SMC has approved Elacestrant and Capivasertib. Now, the priority must be ensuring that every patient who could benefit can actually access the genomic testing required to get them.
We will continue working as part of the Scottish Cancer Coalition to push for funded, equitable genomic testing across all of Scotland. You are not alone in this wait, and we will keep you updated every step of the way.
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