Alexandru Eniu, Chairman of ESO College and Consultant Medical Oncologist and Breast Cancer Specialist at The Genolier Clinic, posted on LinkedIn:
”Chairing and Presenting at ASCO26: Navigating HR+ Metastatic Breast Cancer
Honored to have chaired and presented at the 2026 ASCO Annual Meeting in Chicago yesterday, with a packed Hall D1, a sign of just how pressing this topic is for the oncology community.
With 13+ therapeutic options now available for HR+/HER2- metastatic breast cancer, the challenge is no longer ‘what can we give?’ but ‘in what order, and for whom?’
The reality is: we don’t have randomized data for every possible therapeutic sequence. Algorithms alone can’t cover every clinical scenario.
That’s why I proposed a Decision Framework, beyond the algorithm, built on 5 integrated dimensions:
- Biology: What does the tumor tell us? (ER/PR/HER2, ESR1, PIK3CA/AKT1/PTEN, BRCA1/2, tumor-agnostic markers)
- Disease Kinetics: How fast is this moving? (tempo of progression, visceral crisis, disease burden)
- Prior Therapies: What was the tumor exposed to? (duration of benefit, lines of ET, primary vs. secondary resistance)
- Patient: What matters to this person? (age, frailty, comorbidities, QoL priorities, goals of care)
- Logistics and Access: What is actually feasible? (drug availability, cost, global disparities, trial access)
When guidelines are offering several options, a structured framework helps us make individualized, evidence-informed decisions.
Grateful to ASCO for the opportunity and to all the colleagues who joined the discussion.”
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