Maria Hafez, Assistant Professor at St. Luke’s University Health Network, shared a post on LinkedIn:
“ESMO Breast Cancer 2026: Day 1, Berlin
A strong opening day in Berlin. The unifying message from the Scientific Committee set the tone: improve QoL, tailor treatment to patient and tumor biology, embrace new technologies, and clarify optimal sequencing. With 600 abstracts, 24 sessions, and 61 faculty across 3 days, the programme is dense, and Day 1 already delivered.
A few highlights I took away:
- Liquid biopsies, past, present, and future (Daniel Hayes, Michigan). A masterful walk through the evolution from CA15-3 and CA27.29 to CTCs, ctDNA, miRNA, and exosomes. The reminder that “many assays exist, and they are very different” is more relevant than ever as MRD/ctDNA-guided decisions move into clinical workflows.
- ADCs in HR+/HER2− mBC (Virginia Kaklamani). Three approved options now: T-DXd, sacituzumab govitecan, and datopotamab deruxtecan, but the harder question is sequencing. The attrition data after CDK4/6i (Gennari et al.) was a sobering reminder of why “save it for later” thinking can cost patients access to active therapy.
- Treatment landscape of HR+ MBC. The 1L/2L/3L map is now genomically driven: WT vs PIK3CA/AKT vs ESR1-mutant pathways diverge meaningfully in 2L. Capivasertib, alpelisib, elacestrant, imlunestrant, inavolisib + palbo-the toolkit is bigger, but so is the cognitive load on clinicians.
- Endocrine therapy beyond CDK4/6i (Ana Garrido-Castro, Dana-Farber). The pipeline is rich: selective CDK4i/CDK2i, CDK7i, KAT6i, next-gen SERDs/SERMs, PROTACs, even radioligand therapy. The recurring question remains biomarkers to guide selection and sequencing.
- Immunotherapy across subtypes. A clean snapshot of where we stand: KEYNOTE-522 anchoring early TNBC, KEYNOTE-355 in metastatic disease, two negative phase III trials of atezolizumab in HER2+, and the PD-L1+ small-benefit subgroup question still open. Several ADC + anti-PD1 phase III trials are ongoing.
The throughline of Day 1: we now have abundance-ADCs, endocrine agents, targeted combinations. The differentiator going forward is not access to drugs, but the discipline to sequence them well, guided by biology and biomarkers.
Looking forward to Days 2 and 3, especially the lobular breast cancer keynote, next-generation precision therapy in HR+, and the young women’s breast cancer session.”
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