Matthew Kurian: Top 5 Practice-Changing Trials for Community Oncologists at SABCS 2024

Matthew Kurian, Staff Hematology/Oncology Physician at St. Elizabeth Healthcare, shared a post on LinkedIn:

“SABCS 2024: Top 5 Practice-Changing Trials for Community Oncologists

1. EMBER-3 (GS1-01)

What it studies: Phase III trial evaluating imlunestrant with or without abemaciclib versus standard endocrine therapy in HR+/HER2- metastatic breast cancer previously treated with endocrine therapy with/without CDK4/6 inhibitors.

My take: Could expand treatment options for managing endocrine-resistant disease, with a focus on targeting ESR1 mutations. I’m eager to see if this trial confirms the benefit of extending the longevity of CDK4/6 inhibitors (building on post-MONARCH data) while addressing ESR1 resistance. It’s a logical next step in tackling resistance mechanisms.

2. ELEVATE (PS7-06)

What it studies: A Phase I/II study testing combinations of elacestrant (oral SERD) with abemaciclib, capivasertib, and everolimus in HR+/HER2- metastatic breast cancer.

My take: Could guide multi-agent strategies for managing endocrine resistance with lower toxicity. If the data support efficacy with reduced toxicity, it may help oncologists navigate tough decisions when multiple resistance mutations (e.g., ESR1, PIK3CA, PTEN) are present.

This could open doors to combination regimens addressing multiple resistance mechanisms simultaneously.

3. ZEST (GS2-06)

What it studies: Evaluates adjuvant niraparib for BRCA-mutated HR+/HER2- or triple-negative breast cancer with positive ctDNA to see if it improves outcomes.

My take: Explores ctDNA as a biomarker not only for prognosis but potentially for guiding treatment escalation. This trial could pave the way for ctDNA-based treatment strategies in breast cancer, leveraging its prognostic value and potentially uncovering predictive utility.

4. NSABP B-59/GeparDouze (GS3-05)

What it studies: Neoadjuvant carboplatin/paclitaxel ± atezolizumab, followed by adjuvant atezolizumab in stage II/III TNBC. Key outcomes include pathologic complete response (pCR) and event-free survival (EFS).

My take: Potentially simplifies the regimen compared to KEYNOTE-522 by removing anthracyclines and reducing overall chemotherapy intensity.

If successful, this study could offer a less toxic alternative to KEYNOTE-522’s intensive 24-week chemoimmunotherapy regimen, reducing the long-term risks of secondary malignancies and cardiotoxicity through omission of AC. However, atezolizumab’s track record in TNBC has been inconsistent in the past.

5. NEOHIP (RF3-05)

What it studies: Evaluates neoadjuvant HER2-targeted therapy with/without pembrolizumab to determine if immunotherapy improves pCR in HER2+ early breast cancer.

My take: Explores the synergy between HER2-targeted therapies and immunotherapy in HER2+ tumors, known for their immune-infiltrated microenvironment. This study may identify HER2+ patients who could benefit from treatment de-escalation, sparing them from taxane and platinum chemotherapy.

See everyone in San Antonio!”

More posts featuring Matthew Kurian.

Matthew Kurian is a staff hematology/oncology physician at St. Elizabeth Healthcare and an assistant professor of medicine at the University of Kentucky College of Medicine. His primary focus lies in breast and genitourinary (GU) cancers, where he combines clinical practice with research to improve patient outcomes.

Dr. Kurian has expertise in radioligand treatments, including Lu-177, and has published several peer-reviewed articles on various oncology topics.

He completed his oncology fellowship at the NCI-designated University Hospitals/Case Comprehensive Cancer Center, where he also served as the Chief Fellow of the Hematology/Oncology Fellowship Program for the 2022-2023 academic year.