Vlad Lupu, ESMO Certified Oncology Resident at Oncohelp Oncology Center, shared a post on LinkedIn:
“In my opinion, one of the most interesting topics in Breast Cancer Treatment at ESMO 2025 was the juxtaposition of the ASCENT-03 and TROPION-Breast02 studies regarding the future 1st line standard of care for mTNBC ineligible for ICI therapy.
On one hand, ASCENT-03 was positive for PFS (the single primary endpoint), while showing great signs of being positive for OS at a later time. The most impressive aspect of the study however, was the crossover provided by the study sponsors, a feature that adds significant value to further secondary endpoints.
On the other hand, TROPION-Breast02 was positive for both primary endpoints, OS and PFS, while not providing crossover. In the subgroup analyses, OS was obviously driven by the non-EU/US/Canada subgroup, highlight possible differences in the local availability of ADCs in the second line.
In my view, the difference in study design is providing equivalence in the value added for Sacituzumab Govitecan and Datopotamab Deruxtecan in this setting.
But at this point, the question remains. In the race for the highest level of evidence recommendation, do we reward “playing” by the text-book rules or will we commend the added ethical value through providing optimal crossover (even if not mandated by current guideline recommendations)??”
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