Insight

Armando Orlandi: Day 4 at ASCO 2025 – Key Breast Cancer Clinical Advances

Armando Orlandi/LinkedIn

Jun 3, 2025, 11:15

Armando Orlandi: Day 4 at ASCO 2025 – Key Breast Cancer Clinical Advances

Armando Orlandi, Medical Director at the Agostino Gemelli University Hospital Foundation IRCCS, posted on LinkedIn:

“Day 4: 3.06 – ASCO 2025 – Breast Cancer Clinical Advances

Another pivotal day from Chicago with practice-changing data across the breast cancer continuum.

Here are the key clinical insights:

HER2+ METASTATIC BREAKTHROUGH

DESTINY-Breast09 delivers the ultimate game-changer: T-DXd + pertuzumab vs THP in first-line HER2+ mBC achieved stunning 40.7 vs 26.9 months PFS (HR 0.56, p<0.00001). With 85% ORR and 39-month DOR, CRR 15%!

Attending T-DXd arm alone: practice-changing

DE-ESCALATION STRATEGIES VALIDATED

neoCARHP: THP proved non-inferior to TCbHP (64% vs 66% pCR, p=0.0089) with major toxicity reduction – grade 3-4 AEs dropped from 35% to 21%. Carboplatin can be safely omitted with dual HER2 blockade.

WSG pooled analysis: 12-week HER2 blockade ± chemotherapy achieved excellent 5-year survival (97-98% OS). Patients with pCR after chemotherapy-free regimens showed outstanding outcomes.

PRECISION MEDICINE ADVANCES

CompassHER2: HER2DX genomic test effectively predicts pCR across ER subtypes – high score achieved 68% vs 19% low score (p<0.001). Precision neoadjuvant selection is here.

I-SPY2: ctDNA post-neoadjuvant chemotherapy predicts nodal burden – ctDNA(-) patients: 67% ypN0 vs 33% ctDNA(+). This could guide axillary surgery decisions.

TECHNICAL and SURGICAL INNOVATIONS

AXSANA study: In 2,596 cN+ patients, probe-guided markers (radioactive/magnetic seeds) achieved 96-100% target lymph node detection vs 90% with clips. Technical precision matters.

ENDOCRINE THERAPY UPDATES

ASTRRA: 10-year follow-up confirms OFS benefits – TAM+OFS improved DFS (84% vs 76%, HR 0.68). High-risk patients aged 40-45 showed 11% BCFI improvement.

OASIS 4: Elinzanetant provides first approved option for AET-related hot flashes, reducing VMS by 3.5 episodes/day vs placebo (p<0.0001). Fast onset, well-tolerated.

CLINICAL IMPLICATIONS

Today’s data reinforce the evolution toward precision medicine, thoughtful de-escalation, and patient-centered care. From revolutionary metastatic treatments to optimized surgical approaches, we’re witnessing the future of breast cancer management unfold.

Attached is the photo of our delegation from Oncology Unit at Fondazione Policlinico Universitario A. Gemelli IRCCS Roma (Director Prof. G. Tortora).”

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