Sarah Sammons, newly appointed Co-Leader of Breast Oncology at UMGCCC and former Senior Physician at Dana-Farber, shared a post on LinkedIn:
“Big week for breast cancer at ASCO26. A few highlights from the meeting:
Metastatic
TROPION-Breast02 + ASCENT-03: Two practice-changing Trop2 ADC options for 1L PD-L1 ineligible TNBC. Subsequent analyses confirm benefit. 2 good options.
VIKTORIA-1: Gedatolisib + fulvestrant beat alpelisib in PIK3CA-mutated 2L HR+ MBC with a much cleaner toxicity profile. Triplet did not add anything with Palbo. Less hyperglycemia, less diarrhea. Stomatitis challenge. Will be a nice doublet option if approved. Is IV drug.
SERENA-6: Switching to camizestrant when ESR1 mutation is detected on ctDNA, before progression, yielded 51% ctDNA clearance vs 1.9%. Compelling biology. Let’s see what the FDA does.
persevERA: Giredestrant + palbociclib did not beat letrozole + palbociclib in 1L HR+ MBC (33.1 vs 28.2 mo, p=0.15). The 1L SERD moment has not arrived yet. Metastatic SERD benefit in ESR1 mutant only.
Early Stage
lidERA: First new adjuvant endocrine therapy in decades. Giredestrant cuts recurrence risk about 30% across pre and postmenopausal patients subgroup analyses. Premeno need OFS. FDA submission underway.
KEYNOTE-522 at 7 years: EFS 78.3% vs 69.8%, OS 85.1% vs 77.2%. The benefit is durable and real. But real-world irAE rates up to 54%. We need a biomarker to identify who can safely skip immunotherapy.
OPTIMA: Chemo omission non-inferior in low genomic risk node-positive patients, including N2 using Prosigna. Practice changing for postmenopausal patients. For premenopausal, the key insight is that chemo benefit in low genomic risk patients is largely driven by ovarian suppression, not cytotoxicity. Still need to see more premeno N2 data. Enroll to OFSET.
OASIS-4: Elizanetant improves hot flashes AND sleep across tamoxifen, AI, and GnRH agonist therapy. Non-hormonal and safe for HR+ patients. An adherence tool we have really needed.
REDUSE: Denosumab every 12 weeks after induction is non-inferior to every 4 weeks for skeletal-related events, with less hypocalcemia, less ONJ, and more than 50% reduction in drug costs. Smarter de-escalation with no efficacy tradeoff.
GLP-1 RAs: Real-world data showing 43% reduction in metastatic progression and 30% mortality reduction in HR+/HER2- patients on ET + CDK4/6i. Still observational, but the tumor GLP-1 receptor expression data suggests this is more than just a metabolic effect. Need prospective studies.
Grateful for the science.”
