Armando Orlandi, Medical Director at the Agostino Gemelli University Hospital Foundation IRCCS, shared on LinkedIn:
“ESMO 2026, Madrid, 23–27 October
Breast cancer: what could change in clinic from Wednesday 28.10? Here are the 5 clinical questions the Madrid data should answer։
1․ HR+ early disease: will adjuvant therapy confirm a survival gain?
- NATALEE [phase III] (LBA25): 6-year OS and efficacy with ribociclib + NSAI (pre-planned analysis). Our first real look at OS, where abemaciclib has already shown an impact
- NRG/NSABP B-42 [phase III] (LBA24): final analysis of extended letrozole after 5 years of AI-based therapy
- lidERA [phase III] (538RO): PROs from the first adjuvant oral SERD (giredestrant): adherence (which also means OS) over 5+ years hinges on tolerability
- JCOG1204A1 [ancillary study of the phase III JCOG1204 trial] (542RO): how far ahead of clinical relapse does post-surgical ctDNA surveillance detect recurrence, and does that lead time make a difference?
2․ Will ADCs make it into the curative HER2-low setting?
- TALENT [randomized phase II] (LBA23): neoadjuvant T-DXd ± anastrozole, or sequenced with chemotherapy, in HR+/HER2-low disease
3․ HR+/HER2− metastatic disease: what comes after the CDK4/6 inhibitor?
- FOURLIGHT-1 [randomized phase II] (1842O): atirmociclib, a selective CDK4 inhibitor, + fulvestrant
- KEYNOTE-B49 [phase III] (LBA51): pembrolizumab + chemotherapy. Is there finally a place for immunotherapy in HR+ disease?
- Updates from: postMONARCH [phase III] (1RO): OS with abemaciclib + fulvestrant
- FINER/MA.40 [phase III] (LBA14): OS with ipatasertib + fulvestrant
- VIKTORIA-1 [phase III] (LBA16): gedatolisib + fulvestrant ± palbociclib
- evERA [phase III] (2RO): biomarkers for giredestrant + everolimus
4․ The question of the moment: after an ADC, which ADC?
- SWITCH [prospective phase II platform trial] (4RO): switch the target, keep the payload. Is that enough? Prospective data on ADC sequencing
- PANKU-Breast01 [phase III] (LBA50): izalontamab brengitecan in pretreated HR+/HER2− disease
- Updates from: OptiTROP-Breast01 [phase III] (4639RO): final OS with sacituzumab tirumotecan in pretreated TNBC
5․ Brain metastases: are first-line ADCs the top choice here too?
- DESTINY-Breast09 [phase III] (LBA49): T-DXd + pertuzumab vs THP in HER2+ disease with baseline brain metastases
- TROPION-Breast02 [phase III] (LBA96): exploratory analysis of intracranial activity of Dato-DXd in 1L TNBC for patients who are not immunotherapy candidates
A note on method: not all data carry the same weight. Phase III OS data can shape practice from Wednesday. A phase II trial or an exploratory analysis generates hypotheses, not standards.
The common thread: we are no longer just looking for an active drug. We are building the right SEQUENCE, for the right patient, at every stage of the disease.
Which of these answers would change our practice the most from 28 October?
No results anticipated: the answers will come from the ESMO 26 stage.”
You can also read:
ESMO Congress 2026 Breast Cancer: 10 Abstracts to Watch
