Open Access 14-04-2025 | Breast Cancer | short review
ESMO 2024: highlights in breast cancer
Authors: Simon Udovica, Muna Ferner, Maximilian Marhold, Kathrin Strasser-Weippl, Rupert Bartsch
Published in: memo - Magazine of European Medical Oncology
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Several clinically relevant abstracts in the field of breast cancer (BC) were presented during the 2024 congress of the European Society for Medical Oncology (ESMO). Updates from the phase 3 NATALEE trial supported the role of cyclin-dependent kinase (CDK) 4/6 inhibitors in early-stage hormone-receptor (HR)-positive/HER2-negative breast cancer with intermediate to high risk of recurrence, while an update of KEYNOTE-522 reported an overall survival (OS) benefit with pembrolizumab in early-stage triple-negative disease. In HER2-positive early-stage BC, the phase 2 WSG-TP-II trial reported excellent long-term outcomes with de-escalated neoadjuvant chemotherapy combined with trastuzumab and pertuzumab. A retrospective analysis of endocrine treatment strategies in the pivotal HERA trial emphasized the importance of ovarian function suppression (OFS) in premenopausal patients with HR-positive/HER2-positive disease, even in the presence of HER2-directed treatments. Antibody–drug conjugates (ADCs) remain a key focus of scientific interest. Results from DESTINY-Breast12 support the use of trastuzumab deruxtecan (T-DXd) in metastatic HER2-positive BC patients with active brain metastases (BM), showing high response rates and prolonged disease control in this phase 3b/4 study. The single-arm phase 2 ICARUS-Breast01 trial demonstrated promising results of the HER3-directed ADC patritumab deruxtecan in pretreated patients with metastatic luminal disease. Biological differences between HR-positive/HER2-positive and HR-negative/HER2-positive BC are evident, and DETECT V questions the need for chemotherapy while corroborating previous data supporting the role of CDK 4/6 inhibitors in patients with HR-positive/HER2-positive disease. In patients with metastatic triple-negative breast cancer (TNBC), bispecific antibodies co-targeting PD‑1 or PD-L1 and VEGF showed promising results. Despite sound clinical rationale, inhibition of the PI3K/AKT/mTOR pathway in metastatic TNBC remained unsuccessful in the CAPItello-290 trial.
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