News flash: Updates from the 2026 ASCO Annual Meeting

LBBC welcomed Amy Comander, MD, FACLM, to share the most recent breast cancer findings from the 2026 ASCO Annual Meeting. Watch the recording to learn the latest medical breast cancer research presented at this year’s ASCO Annual Meeting and how this news may impact you. Attendees had the opportunity to ask Dr. Comander questions during the webinar.

Transcript

Amy Comander, MD, FACLM (00:00:09):

ASCO is an amazing experience, but it’s also a very overwhelming experience. It truly is the largest cancer conference in the world. And when you go to ASCO, if any of you have ever attended, it really is overwhelming. There’s a million things going on at the same time, so you really do have to plan out your day because otherwise it can just feel very overwhelming.

(00:00:35):

There’s many abstracts, many presentations all happening at the same time. And therefore as I prepared this presentation tonight, I really wanted to focus on what are some of the key updates that I thought you all would be interested in. But I will say there are many others so we can’t cover everything, but this is a good place to start.

(00:00:53):

I also want to highlight that in addition to sharing all the amazing updates and treatments that we have for breast cancer and other cancers, which of course is super exciting, I was also so happy to see this year that there were many studies focused on supportive care as well as how we can optimize cancer survivorship. June does happen to be National Cancer Survivors Month. So it was really great to see presentations focused on this as well. And hopefully I will have time this evening to get to some of those presentations as they relate to breast cancer.

(00:01:29):

I thought I’d start off by just highlighting the importance of clinical trials. All the progress that we’ve made in treatment of breast cancer, and of course other cancers, is because of amazing women and men who have chosen to volunteer to participate in a clinical trial to help move the field forward. And for all of you on here who have been on a trial or you’re thinking about a trial, thank you. As a breast oncologist, I’m also truly grateful.

(00:02:00):

I’m sure many of you here are familiar with what I mean by a clinical trial, but I just wanted to define it briefly. So these are research studies, which are testing new treatments in people, not just in a petri dish or in an animal model. These are rigorously protected. We have independent safety boards that are monitoring every step to ensure that the patients who participate are safe. Participating in a clinical trial is certainly voluntary, and we do informed consent. In my own clinic today, I told two patients about a trial they might want to participate in, gave them the consent form, they took it home to read it, and then they’ll decide if they’re interested in participating or not. It’s up to the patient. And of course, these are driven by science often due to amazing lab discoveries that lead to interest in developing new drugs.

(00:02:51):

So why participate? Participating in a clinical trial gives you access to new cutting edge therapies that may not otherwise be available to you for many years. And you’re also benefiting future patients. Whenever I have a patient on a trial, I’m like, “Thank you. You are helping the next generation of individuals who are diagnosed with breast cancer because you’re helping us define better therapies.” And of course, it’s very important that we close equity gaps and ensure that we have diverse enrollment on trials to ensure that these treatments work for all individuals.

(00:03:24):

At the bottom of the slide, I really highlight that we know that, due to advances in treatment as well as improvements in early detection, the 5-year survival rate from breast cancer has significantly improved. In the 1970s, it was around 75%. Now we’re well over 91%. That’s amazing. And of course, we want to continue to get even better in terms of those statistics.

(00:03:46):

Some of the concerns people might have about being on a trial are listed here, and I’ve heard these concerns from my own patients in my clinic worried: Am I just going to get a placebo? And I think it’s important to know. It’s great to ask about that, but if you’re on a clinical trial, you will usually at least receive the standard of care. So you do need to always clarify that, but a placebo alone is rarely used. Another concern might be, “Trials are a last resort by doctors mentioning this only because there’s nothing else to give me.” And that is certainly not true. We have clinical trials for patients at every stage, early stage, advanced stage, supportive care. So a trial is not a last resort.

(00:04:30):

There’s a concern, I’ll lose control of my care. And I think that’s also a misconception because, again, informed consent is done and if you’re on a trial and it’s not working well for you and you don’t want to be in it anymore, you can withdraw. Obviously we discuss that with your team, but no one forces you to stay on a trial. And certainly if there’s any updates to the protocol, we communicate that very well to our trial participants.

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Finally: It’s too much work. I will say that’s a good thing to ask about. Some trials do have extra visits, some trials do not. Usually a benefit of being on a trial is that you have a research team working with you and so they can help you understand exactly how many extra visits and maybe they could be scheduled based on how it works for your schedule.

(00:05:15):

Just raising awareness about the importance of participating in clinical trials. Ask your team about trials. You can look on clinicaltrials.gov to know what trials are open everywhere. And of course, many cancer centers have nurse navigators or research navigators that can help you explore this as well.

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Now let’s get to the updates. So for those of you who are here, I’m sure you are quite familiar. I see a lot of information shared in the chat, which is amazing, that breast cancer is not one disease. It’s not one disease. I think you all know this, that there are three main subtypes, but of course as we learn more about genomic profiling, we’ll maybe going to be able to refine this even better. But just to think in broad strokes, the majority of breast cancers in the United States are what we call hormone receptor positive, meaning they express the estrogen receptor, potentially the progesterone receptor, and they’re HER2 negative. And then about 15% to 20% of breast cancer is what we call HER2-positive and then another 15% are what we call triple-negative. So as I discuss the trials tonight, I’m going to make sure I explain which subgroup that trial does apply to.

(00:06:28):

Now let’s get started with early-stage breast cancer. And I picked three studies which I thought were particularly relevant to review with you all this evening. The first one is called OPTIMA. The second one is an update on the lidERA study. And the third one is an update on the KEYNOTE-522 study.

(00:06:48):

I can tell you each of these trials came up in my clinics this week with my patients, just talking about their treatment plan and saying, “Wow, at ASCO 2 weekends ago, we learned about this study, which is really relevant to your care.” These are all relevant. So that’s why I chose these particular studies.

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I’m going to go through them. I’m going to try not to go too fast, but I want to just convey the key concepts and points. And certainly if there’s interest in learning more about them, you can read more about them.

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But one trial that did get a lot of press is something called the OPTIMA study. And so that’s the first one I’m going to tell you about. This abstract reported on first results from this OPTIMA phase III randomized trial — randomized, noninferiority, we’ll explain what that means shortly — of test-directed chemo in patients with high clinical risk, estrogen receptor-positive, HER2-negative early-stage breast cancer.

(00:07:47):

Here’s some background about the study. Many of you are probably familiar with tumor gene expression assays. Maybe you’ve heard about the Oncotype, maybe you’ve heard of the MammaPrint. As you know, these tools are widely used to help oncologists make decisions about chemotherapy in particular for our postmenopausal patients with early-stage breast cancer usually up to three involved lymph nodes. And certainly we use these tools for our premenopausal patients as well, but there is some controversy sometimes about using these gene expression assays in our younger patients. In addition, once we get above three positive nodes, sometimes we’re not super comfortable using these gene expression assays.

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So where does OPTIMA come in? This was an international randomized controlled trial that specifically focused on high-risk patients. And the hypothesis was that the number of involved lymph nodes should not affect chemotherapy response if an individual’s tumor has a low test score. And why is that concept? Where’s that coming from? Maybe the biology of the tumor should, even if there’s maybe four or five positive nodes, if the tumor has a lower test score, perhaps the biology is still more indolent and that patient’s tumor would not respond as well to chemo.

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This OPTIMA study used a test called the Prosigna test, a 50-gene test. It’s a gene expression assay that is now going to be available in the U.S. If you haven’t heard of it before, it’s probably because it wasn’t available here, but it will be soon. If a tumor was sent for this test and it had a risk of recurrence score greater than 60, that’s considered a high-risk tumor.

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Here’s what the investigator shared as the design. So whenever we saw a presentation at ASCO about any clinical trial, the investigators do share the design to help all of us understand who is eligible and how do they actually do this trial. So we always want to know who is eligible. That is key. This was for women and men age 40 or older who already had had their breast cancer removed surgically. Their tumors were estrogen sensitive, HER2 negative and they could have up to nine positive lymph nodes to be on this study. And these patients did not receive neoadjuvant chemo, which is chemo given before surgery.

(00:10:18):

As I mentioned earlier, whenever somebody enrolls in a trial, we do informed consent. So people were consented if they wanted to be in this study, and then they were randomized — that’s what the R means — to one of two groups. You may be randomized to go ahead and get your chemo followed by endocrine therapy, and that’s the arm you got randomized to. Or maybe an individual is randomized to have this gene expression test sent, called the Prosigna, and then the score comes back. It’s either over 60 or under 60. And so for those individuals with a low score, under 60, they proceeded with endocrine therapy alone.

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I should note, for the premenopausal patients, endocrine therapy did include ovarian function suppression for all of those individuals. So they were getting, whether it’s Lupron that’s used in your cancer center along with either tamoxifen or an aromatase inhibitor, they all got ovarian suppression. If individuals in this group had a score over 60, they did get chemo followed by endocrine therapy.

(00:11:21):

These patients were followed, as you can see, and I should say the people who went straight to chemo and endocrine therapy ultimately did have the gene expression assay test sent as well.

(00:11:33):

What’s important to note, there were lots of figures in this presentation, but I wanted to highlight the key concepts. For those individuals, even if they had multiple positive lymph nodes, if the score was under 60, it was found that there was a minimal benefit of chemo. So this is another example of a gene expression test showing us that if it’s a very low score, which reflects the biology of the tumor, we can avoid giving chemo even in premenopausal women — again, 40 and older, but they were all getting ovarian function suppression. So I think that’s really important. And it also was useful for individuals with multiple positive lymph nodes.

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This is a slide that the researcher who gave the presentation shared at the end. They all have these lay summaries, which are really nice. I included them when I could find them just to show what are the key points for all of us to understand.

(00:12:32):

The point of doing this study was to reduce unnecessary chemotherapy administration for patients with hormonally sensitive breast cancers using this Prosigna gene test. And again, they did show that for patients with a low-risk score, there was a very minimal, maybe at most 2%, benefit of chemotherapy, and this did apply to women in their 40s and older or patients with more than three positive lymph nodes.

(00:12:59):

I think the key concept is that these gene expression tools are very useful. We will now soon have Prosigna available to us. And the concept is we really only want to give chemo to the patients who are truly going to benefit because we know chemotherapy has many side effects, complications, and we want to avoid that if we don’t have to expose our patients to that.

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So that is the Optima study. We can discuss it further in a few minutes.

(00:13:25):

What’s another key study that was presented? So many of you maybe are familiar with this. I know my patients in my clinic this week were asking me about it, the lidERA study. Many are familiar with this concept of using this drug called giredestrant, which we’re going to talk about in a second, in patients also with hormonally sensitive, HER2-negative early-stage breast cancer. And in this particular study, they were breaking down the results by menopausal status. This study was presented at the San Antonio Breast Cancer Symposium in December, but this particular analysis was shared at ASCO this year.

(00:14:02):

I found this figure from the New England Journal of Medicine because I feel like sometimes all of these different types of hormonal therapy drugs can be very confusing. And I love this figure because it really makes it quite clear how all these different medications are working. So we’re just going to take a quick look at this first.

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We’re thinking about these are hormonally sensitive tumors, which are driven by estrogen. We know that without any estrogen blockade or any medications, estrogen, which is this pink little circle, can bind to the estrogen receptor within the cell causing a confirmational change of the receptor, which then goes into the cell nucleus and can result in transcription of genes that can cause the cells to proliferate and grow. So that is sort of what estrogen’s doing if it’s unopposed.

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For example, an aromatase inhibitor. What is that doing? That is lowering production of estrogen in the first place. So there’s no estrogen to go in. What about a drug like tamoxifen, which is a SERM, a selective estrogen receptor modulator? It’s competitive with the estrogen to get to the receptor and usually the tamoxifen wins. Also it alters the confirmation of the receptor. So the receptor, when it goes into the nucleus, it can’t do its job to cause these genes to be transcribed, to result in tumor growth, et cetera.

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What’s giredestrant? It is in this category. It’s a really potent selective estrogen receptor antagonist and degrader, super cool. And some other drugs in this category you’ve probably heard of, fulvestrant, elacestrant, imlunestrant. They all kind of rhyme. What are they doing? They’re the green dots. So they are going to bind to the receptor and then this E3 ligase complex comes around and then the receptor gets degraded. So it goes away. It’s getting put into the trashcan of the cell. Think of it that way. And similarly, you maybe have read about or heard about these proteolysis targeting chimera drugs. We’re not going to get into this today, but just showing again, what are they doing also causing the estrogen receptor to be degraded.

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Super cool, right? I love this figure because it really helps us understand how these drugs are working in the first place.

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OK, let’s talk about giredestrant. This is the eligibility criteria for the lidERA study. Again, these were individuals with stage I to III breast cancer, hormonally sensitive, HER2-negative, and they did have to have higher risk tumors to be eligible to be in this study. They could be pre- or postmenopausal, which is important to note. In this study, which included over 4,000 individuals, which is amazing, they were randomized to either get the giredestrant or standard-of-care endocrine therapy, which could be tamoxifen or an aromatase inhibitor. And then they’ve been followed to look at how do they do, how do they tolerate the medication and of course looking for risk for recurrence, something called disease-free survival. If they’re going to have a recurrence, how long does it take for that to happen? Obviously we don’t want it to happen, but we need to know this information about assessing how effective the medication is.

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Of note, an important bullet point, and it’s in red here, ovarian function suppression with an approved LHRH agonist was required for all men and premenopausal women who are receiving certainly an aromatase inhibitor but also giredestrant. So I think that’s an important point for us to recognize.

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We know from the lidERA study that there was a significant and clinically meaningful benefit in terms of something called invasive disease-free survival with use of the giredestrant over standard-of-care endocrine therapy. I didn’t want to show a lot of graphs, but I’m showing this one just to show that at 3 years of follow-up, there was a significant benefit in terms of disease-free survival 92.4% versus 89.6% in favor of giredestrant. And also overall survival trended in favor of the giredestrant arm. That’s why there’s so much excitement about this class of medications.

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What about side effects? This is a figure which kind of demonstrates the side effects, particularly in the purple is the giredestrant and the gray is standard-of-care endocrine therapy and they broke it down by premenopausal and postmenopausal. And you can see the distribution of side effects was pretty similar between the two groups and comparable. I will say, as you would expect, unfortunately, arthralgia or joint pains and hot flashes were still the most common adverse side effects regardless of menopausal status. I think what’s important to note is that fewer discontinuations of therapy with giredestrant occurred compared to standard-of-care endocrine therapy regardless of menopausal status. And this is focusing really on the joint pains in particular that they were a little better tolerated with the giredestrant compared to standard-of-care treatment.

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Let’s get to this lay summary, which was provided to us. We do know that this drug, giredestrant, is very exciting. We think that there’s improvement in what we call invasive disease-free survival, and the drug is beneficial for individuals who are premenopausal or postmenopausal. Both groups benefited from use of this medication. We also know joint pains and hot flashes are still unfortunately the most common side effects. And remember that individuals on giredestrant who were premenopausal were on ovarian function suppression as well, but there was fewer treatment discontinuation of the giredestrant. So this is certainly very exciting and giredestrant is a powerful medication and definitely excited to learn more about this and hoping we’ll have opportunities to offer to our patients soon. That is a quick summary about the giredestrant medication, and we’ll talk about this medication in advanced breast cancer as well when we get to that section.

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Finally, last but certainly not least, I wanted to focus on a different type of breast cancer. This is triple-negative breast cancer, which we know comprises about 15% of breast cancers in the United States. So many of you are probably familiar with this term the KEYNOTE-522 study, because this study was started a number of years ago. But at ASCO this year we had the opportunity to learn about the final analysis in terms of results from this important phase III KEYNOTE-522 study, which was evaluating neoadjuvant pembrolizumab — neoadjuvant means a treatment given before surgery. So neoadjuvant pembrolizumab or placebo — so there is a placebo in this trial, but you’ll see that patients are still getting appropriate therapy because they’re still getting chemo followed by adjuvant, which means after surgery, pembrolizumab or placebo for high-risk early-stage triple-negative breast cancer.

(00:21:08):

We’ve heard about this study. For those of you on here who have a history of triple-negative breast cancer, you’re familiar with this. This study has been published and presented numerous times, and we know that adding pembrolizumab — which is immunotherapy, very exciting — along with chemo has led to statistically significant and meaningful improvements in pathologic complete response rates. What happens to the tumor after chemo? Do we see it melt away, something called event-free survival and overall survival, as compared to chemo alone in individuals with high-risk early-stage triple-negative breast cancer? We’ve known this and it’s been reported in numerous studies, but now we have the data with a median follow-up up to 94 months. We want to see does this amazing result we see with the addition of pembrolizumab persist even with longer follow-up. So that was the point of this presentation.

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Just to remind you all about the study design, I guess we’re getting a little bit more comfortable with looking at these figures, again, the eligibility criteria outlined here. Individuals had to have a new diagnosis of triple-negative breast cancer and either it was node positive or T2 means it’s greater than 2 centimeters, T2 to T4, and it could be node negative if it was greater than 2 centimeters or there could be nodal involvement and patients were randomized. I mentioned earlier, everyone does get the standard of care. So in this particular figure, everyone got carboplatin and paclitaxel followed by an anthracycline drug such as doxorubicin or epirubicin along with cyclophosphamide. That is standard of care. Or if they got the arm with the intervention, they were randomized to get the immunotherapy, the pembrolizumab. And so they got their neoadjuvant treatment and then ultimately had surgery and then those individuals on the pembrolizumab arm continued on pembrolizumab for up to 27 weeks after surgery. And those who did not get the pembrolizumab obviously were continuing on a placebo.

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What were the endpoints of this study that were being evaluated? Pathologic complete response rates, event-free survival, and of course looking at overall survival. This is such an important study in our field. It’s really truly a game changer.

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I wanted to just share a quick slide about the treatment-related adverse events. I mean, we know this chemo regimen is hard. I think anyone on here who’s been through this can attest that this is a very hard regimen. This is what I tell my own patients. Adding the pembrolizumab, adding immunotherapy does unfortunately increase risk for toxicity. We do know this. In fact, one of my colleagues at MGH, Dr. Kerry Reynolds, is very interested in understanding and characterizing immune-related toxicities because this is a new field that we’re learning about. So certainly for individuals receiving immunotherapy, there’s close monitoring for thyroid problems, blood counts, all the kind of things that we have to keep a close eye on as you can see in this slide.

(00:24:17):

But importantly with median follow-up now close to 8 years, this presentation showed that this final analysis of KEYNOTE-522, that adding the pembrolizumab to neoadjuvant chemo followed by adjuvant pembrolizumab provides a significant benefit in terms of survival for patients with high-risk early-stage triple-negative breast cancer and they broke it down by all different types of subgroups as we’ll talk about later, and there was benefit regardless of pathologic complete response status, reducing risk of recurrence.

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The reason I chose to highlight this is this study further illustrates that for triple-negative breast cancer, which is an aggressive form of breast cancer, adding the pembrolizumab up front in the neoadjuvant setting along with platinum-based chemo is now the standard of care. This is so important, and we are seeing improved outcomes because of this study. I just felt like this was very important to highlight.

(00:25:15):

That was a lot of information. Here’s the plain language summary, which further illustrates the importance of the KEYNOTE-522 study, but I know we’re going to take a brief break to talk about some questions about early-stage breast cancer. So I’m going to turn it over to you, Jean.

Jean Sachs, MSS, MLSP (00:25:33):

Yeah, thank you. And everyone has great questions and they’re already anticipating for our metastatic people joining us.

(00:25:41):

Let’s start with the OPTIMA trial. Super exciting because this can be used for people with extensive lymph node involvement. So the big question is: When is this going to be ready and at market? And obviously for people on tonight, they probably will not have the benefit of using this. But what do you know about that?

Amy Comander, MD, FACLM (00:26:05):

Great question. I looked it up myself right before this webinar because I was curious, I’ve never ordered this Prosigna test myself. And what I found is literally just a few days ago after ASCO, this test will now be available certainly for order in the United States. When will it be available at my hospital or your hospital? Exactly, I don’t know, but it will be available. So that is super exciting because that does raise a really good question. Can we extrapolate to use Oncotype or MammaPrint if we don’t have the Prosigna test? And I have to say, I would be careful about that. I would like to see this test in my own hospital so I can order it on my patients.

Jean Sachs, MSS, MLSP (00:26:47):

Yeah, I think that’s a question too is how does this correlate if you had Oncotype or MammaPrint? And I think it’s important to say that this test has been around for a really, really long time. It’s just been used more in the lab. So we’re really excited. LBBC is going to be creating content on this so you can keep coming back and learning more.

(00:27:07):

I don’t know if you can answer this question, but what if you’re … In early stage, they don’t really look at HER2-low because there’s a question about that and would this test?

Amy Comander, MD, FACLM (00:27:20):

That’s such a great question, and I know it’s confusing. In fact, I was trying to explain that to a patient today, the HER2-low, how it’s not really important in terms of her presentation. She’s HER2-negative.

(00:27:32):

So HER2-low is a relatively new concept for us in oncology, and it’s really now something we think about more in advanced breast cancer. But whoever asked that question, amazing, because maybe we will soon be at a point where we’re thinking about that in terms of being more precise with our therapies for people with early-stage cancer. But we’re not doing that just yet.

Jean Sachs, MSS, MLSP (00:27:54):

OK. So I’m going to move to the SERD, the degrader, which is exciting. So the first question is: Has this been approved by the FDA? Is it available?

Amy Comander, MD, FACLM (00:28:05):

So not yet. My understanding is in the fall, and I am being vague, I think I saw something about November, but I don’t want to commit to that because that can change. But my understanding is that soon. And exactly which patient population will it be approved for? Obviously, I don’t have the answer to that, but it is super exciting. I already have had patients ask me about this in clinic this week, and I’m like, I know it’s very exciting, but we just have to hold our horses a little bit.

Jean Sachs, MSS, MLSP (00:28:36):

And again, as soon as the approval, when and if it happens, Living Beyond Breast Cancer will alert the community. So for those who are higher risk and are on a CDK 4/6, this particular question was about Kisqali, but can the SERD be combined in the same way that an AI can?

Amy Comander, MD, FACLM (00:28:57):

Love this question, very intelligent. I was about to comment on that, and one of my patients asked me that on Tuesday. She’s on ovarian suppression. She’ll go on an aromatase inhibitor, and then she’s going to go on abemaciclib. So she asked me, “If giredestrant is approved, can you just switch me to that along with the CDK 4/6 inhibitor?” And I would say, as of today, 2026, the answer is no. We do not have data for early-stage breast cancer combining giredestrant with a CDK 4/6 inhibitor. I’m going to show you data in a few minutes for advanced breast cancer, but we don’t have that for early-stage breast cancer.

(00:29:37):

One way I discussed with my own patient this week was maybe we’ll start you on your AI, we’ll add your abemaciclib, you’ll do your 2 years of therapy and 2 years from now perhaps we can transition you from the AI to giredestrant. And I’ve heard other colleagues talk about this strategy as well.

(00:29:56):

Excellent question. We obviously are going to need trials using adjuvant CDK 4/6 inhibitors along with giredestrant in the early-stage setting, but we don’t have that information yet.

Jean Sachs, MSS, MLSP (00:30:07):

Perfect. I’m going to do one more question, and then we’ll keep going. What about giredestrant and your bone health? Does it have the same impact on putting you at risk in your bone density?

Amy Comander, MD, FACLM (00:30:20):

Such a great question, and wow, your audience is amazing. So if we look at, this is called a tornado plot, so cool. Anyway, osteopenia is on here, and I will say remember the premenopausal patients were on ovarian suppression at the same time. So that certainly is going to impact the bone health because we’re putting a person into early onset menopause with ovarian suppression. So it does look like based on this figure, the risk for osteopenia was quite similar between the two groups. But it is a great question if someone were on giredestrant alone without ovarian suppression. It looks like it might be, at least in the postmenopausal group, maybe it’s, I don’t know if that’s significant or not, but maybe a little bit less. But a really great question. So bone health, I think we’re going to need more data about that.

Jean Sachs, MSS, MLSP (00:31:14):

OK, that’s great. I had one other question, but you know what? Given the time, let’s move to the next group of slides around metastatic, and I’ll come back.

Amy Comander, MD, FACLM (00:31:26):

Great questions, everyone. Thank you. Thank you, thank you. As you can see, research just leads to more and more questions.

(00:31:32):

OK. In advanced breast cancer, there were so many things I could have focused on. So I picked two important studies. And again, the first one is focus on triple-negative breast cancer, and the second is focused on estrogen receptor-positive breast cancer. And I’m sorry, I couldn’t cover everything.

(00:31:50):

Let’s talk about the first one, which is ASCENT-04, maybe you’ve heard of that. And I wanted to start off, before we get into that, explaining the mechanism of action of antibody-drug conjugates, which are super cool. I’m sure your doctors told you they’re super cool. So examples that you’ve probably heard of, sacituzumab govitecan, trastuzumab deruxtecan. These are drugs I use in my own clinic all the time. So how are these drugs working? And I showed this to a patient today because I wanted her to understand what was going on in her body.

(00:32:22):

An antibody-drug conjugate is an antibody. That’s what this little Y thing is in green. The antibody is going to an antigen, which here’s an example, a little protein on the surface of the cancer cell. It looks nice and innocent. That’s why I put this Trojan horse here. It looks so nice. It’s just a little antibody, but it’s bringing chemo, a cytotoxic agent, with it. So it goes into the cell, like the Trojan horse. It’s going into the cell and then all of a sudden the cytotoxic agent is released from the linker and it can go do its dirty work. So it can damage the DNA and the cell nucleus. It can go off — this is super cool — into the microenvironment around the tumor and go into neighboring breast cancer cells to do damage.

(00:33:12):

So that is how these drugs are working. Super cool. Of course, depending on which antibody-drug conjugate we’re talking about, it’s going to be targeting a different antigen on the surface of the cell. But super cool.

(00:33:25):

And this is an area of ongoing research. These are just the two drugs that we know a lot about, but there’s so many more. I’m so excited for our field and for all cancers to have access to these amazing drugs.

(00:33:37):

So ASCENT-04, perhaps you’ve heard about it before, but this was a study looking for triple-negative breast cancer, advanced triple-negative breast cancer, which I’m just going to say is a very difficult type of breast cancer to treat when it’s in the advanced setting. And this is a major breakthrough. So this study was looking at can we use this antibody drug conjugate sacituzumab govitecan along with immunotherapy versus chemo and immunotherapy in patients in the first line setting. And these were people with PD-L1 positive, advanced triple-negative breast cancer. What does that mean? It means that they overexpress this PD-L1 protein, which means that it’s felt that they’re more likely to respond to immunotherapy. So that’s the subgroup that we’re looking at.

(00:34:24):

I think what’s important about this study, the take-home message I would like you to think about, is we knew this is beneficial, but we always want to push the field forward. Does it really work in all the different types of subtypes of triple-negative breast cancer? And that’s what this study was really looking at, different subtypes like looking at if there’s a mutation in BRCA1 and 2, does this regimen work. If there’s HER2 amplification within the breast cancer, does this work? So that’s what was really looked at in this study, looking at different subgroups. Also Trop-2, which is the ligand that sacituzumab govitecan is going after. So super cool.

(00:35:05):

They did these exploratory analyses to look at these different molecular subgroups. Another key concept in oncology, molecular subgroups. How can we get better at defining who is going to respond to our treatments? Very exciting.

(00:35:22):

I will just quickly summarize that who were the people in this study: previously untreated, locally advanced, unresectable or advanced PD-L1 positive, triple-negative breast cancer randomized to either get sacituzumab govitecan, the antibody-drug conjugate, along with pembrolizumab immunotherapy versus chemo and immunotherapy. And the endpoint was looking at what we call progression-free survival. Of course they were characterizing these tumors like looking at these biomarkers, et cetera, that I just mentioned specifically something called Trop-2 expression, BRCA status, and HER2 expression.

(00:35:57):

And the major point I want to drive home, so cool, sacituzumab govitecan and pembrolizumab did show a benefit in terms of longer progression-free survival versus the chemo and pembrolizumab across all of those different subgroups. So it is further highlighting that this regimen for PD-L1 positive triple-negative breast cancer is the first-line therapy, and that is really cool and major and exciting.

(00:36:25):

There’s a lot of text on this slide, which of course was presented at ASCO. But again, if you look at the highlight at the bottom, really reinforcing that this should be the first-line treatment for patients with previously untreated advanced PD-L1 positive, triple-negative breast cancer regardless of these biomarker subgroups. Really, really exciting. And this is, I feel like a major advance in our field as we think about treatment of triple-negative breast cancer in the advanced stage, which traditionally was a very hard type of breast cancer to treat.

(00:36:57):

And now switching gears, and I’m sorry I’m talking fast, we just want to cover a lot. Someone asked about giredestrant and palbociclib. Someone asked about that previously in early-stage breast cancer where we do not have data yet. But what about an advanced breast cancer? And that’s what this study was looking at.

(00:37:16):

Our friend giredestrant, which we talked about earlier, along with palbociclib, which is one of the three CDK 4/6 inhibitors versus what we consider standard-of-care first-line therapy, letrozole plus palbociclib. So they were looking at these two regimens for individuals with estrogen-sensitive, HER2-negative, locally advanced or metastatic breast cancer. And this was a phase III trial. It’s called the persevERA BC trial. Love these names.

(00:37:46):

Just reminding us, bringing up my figure, again, giredestrant is a selective estrogen receptor degrader. It’s just to remind us exactly of the mechanism of action as compared to the aromatase inhibitor. We know, for those of you here who unfortunately have a diagnosis of advanced estrogen receptor-positive breast cancer, endocrine therapy with a CDK 4/6 inhibitor is the current standard of care first-line treatment. It is amazing. I saw one of my patients today. She’s been on that for 6 years, doing so well. This has been a major breakthrough. So the question is: If we substitute the aromatase inhibitor for giredestrant, is that going to be even better? And that’s where this concept came through for this particular study.

(00:38:32):

This was the first analysis of this comparison. And again, showing you the figure, how they broke it down, who is eligible. We already kind of mentioned this, individuals with advanced estrogen receptor-positive, HER2-negative breast cancer who did not have any prior treatments, who never had a SERD before. And so those were the key criteria. They were randomized to get the giredestrant plus the palbociclib versus an aromatase inhibitor along with the palbociclib, and they were followed and we’re trying to determine what is the primary endpoint, investigator-assessed progression-free survival. And then secondary endpoints will be looking at overall survival and these other factors noted here.

(00:39:15):

I think what’s important to note, this is what the investigator shared, this primary endpoint, looking at invasive progression-free survival. And there is numerically, if you look at this table on the right, those individuals on the giredestrant and the CDK 4/6, their median progression-free survival was 33.1 months versus on the AI plus palbociclib, it was 28.2 months. But for the statistics experts here, we always look at the P value. We want it to be less than 0.05. And I have to say it is not statistically significant. So there is some benefit, but we definitely want to see statistical significance to really drive this home.

(00:39:59):

The author’s key points are listed here. There was some improvement, but it was not statistically significant. They did share data in terms of tolerability, and it was well tolerated, which was great. And they did conclude that further exploration will be needed to see which patients might benefit from giredestrant in the first line setting.

(00:40:19):

Thinking back to the previous study, ASCENT-04, maybe there’s certain subtypes of estrogen receptor-positive advanced breast cancer, which will benefit more from this regimen. So more to come on this.

(00:40:30):

That was a quick, quick summary of two studies. And Jean, I’m going to turn it over to you if we want to do a quick Q&A about these studies.

Jean Sachs, MSS, MLSP (00:40:38):

Yes, we do. Thank you, again.

(00:40:44):

One thing a couple people have mentioned, and I just think it’s important to bring up. Great news about the Trodelvy-Keytruda trial, but not to minimize the fact that these are hard drugs to take and that this person said she wasn’t able to finish it. She was so sick with the chemo. So again, just wanted to bring to everyone’s attention that we’re aware it’s great to have new drugs, but we also need to make them tolerable.

Amy Comander, MD, FACLM (00:41:11):

I 100% agree. I’m with you 100%.

Jean Sachs, MSS, MLSP (00:41:12):

Yeah, I know you are.

(00:41:15):

There are questions, and I think it’s both, it’s really for our early stage and our metastatic, but they want to understand the difference between fulvestrant and our new oral SERDs.

Amy Comander, MD, FACLM (00:41:26):

I know. Great question. I brought up our slide because it helps us.

(00:41:31):

The big difference that I’m sure everyone could think of is fulvestrant’s a shot. Right? You have to get a shot in your butt, and I’ve had many patients tell me that it really does hurt. Anyone who gets these shots, you’re amazing because I’m sure it’s not fun to come every 4 weeks and get a shot in your butt. So the fact that these other ones are oral, elacestrant is oral, imlunestrant is oral, giredestrant is oral. Amazing. So I think that’s the biggest thing, the quality of life of not having to come in every 4 weeks to get a shot is huge. But in terms of the general mechanism, it is pretty similar as demonstrated here. It is competing, again, estrogen’s the little pink circle and the estrogen receptor degrader is the green circle. So they’re competing for the estrogen receptor. But these drugs are pretty potent, and so they can beat the estrogen to bind to that receptor and result in its destruction. So are they all compared head to head with each other yet? No. But the biggest difference I’d say is a shop versus a pill, and I’d vote for a pill any day.

Jean Sachs, MSS, MLSP (00:42:40):

And also for less time in the hospital.

(00:42:44):

One more giredestrant question is, I don’t know if you’ll know the answer to this, but is it more likely that that will prevent an ESR1 mutation from popping up or we just don’t know?

Amy Comander, MD, FACLM (00:43:01):

Yeah, such an interesting question. Typically, we think of these drugs like elacestrant, imlunestrant as being the drug we would switch someone to if they have an ESR1 mutation. Yeah, that’s such a great question. Will using giredestrant in the first-line setting prevent development of an ESR1 mutation? And I think we don’t know the answer to that yet. So I am sure there’s people doing research, collecting circulating tumor DNA, molecular studies, to help us understand that. But I think that’s an area we just don’t know the answer to yet. Super interesting question.

Jean Sachs, MSS, MLSP (00:43:38):

Yeah, thank you. I agree. So there are a couple of questions in here about SERENA-6 and the idea of using molecular testing to see if you have a molecular progression before something is coming up on a scan. Wondering if you can address that.

Amy Comander, MD, FACLM (00:43:56):

Yes, it’s an interesting study and I think so fascinating for our field as well, really thinking outside the box and how do we incorporate molecular testing into care of patients with breast cancer.

(00:44:08):

Just a quick refresher, SERENA-6, patients were on CDK 4/6 inhibitor, their aromatase inhibitor on for a period of time and then every 2 to 3 months when they were getting their scans they also had their blood drawn look for an ESR1 mutation or other changes. And if an ESR1 mutation was noted, then that’s when patients were randomized to either continue on their aromatase inhibitor and their CDK 4/6 inhibitor or switch to a SERD, a selective estrogen receptor degrader. They used camizestrant. I know they all kind of rhyme, but a SERD. And they got camizestrant, an oral SERD, along with their CDK 4/6. And what was really interesting is there was a benefit in terms of progression-free survival for early switching. This was before you saw a change on the scan. You saw a change in the molecular testing.

(00:44:59):

So super interesting and thought provoking and novel. And I feel like we are going to see more research and more trials in this area. And it does make me think with my own patients, should I be doing molecular testing a little bit more frequently to look for ESR1 mutations for my patients on a CDK 4/6 inhibitor and AI to potentially switch their therapy earlier. So definitely a thought-provoking study and I’m sure we’ll have more research presented on this soon to help guide us.

Jean Sachs, MSS, MLSP (00:45:25):

And a great role for patient advocates to push for this that wanting to know about potential progressions earlier. While we’re talking about metastatic breast cancer, this wasn’t part of your presentation, but there’s a question: Will an ADC be available in first line? And I know there’s been a recent approval, so if you could talk about that.

Amy Comander, MD, FACLM (00:45:48):

Yeah, let me find my little … Where is it? Such a great question. So certainly we just talked about it. Here we go. For triple-negative breast cancer, PD-L1 positive, thinking about again, sacituzumab govitecan, which is an ADC, along with pembrolizumab. And then there’s HER2-positive breast cancer, which I’m sorry guys. I love talking about that too. I just wanted to make sure we had time, and I wanted to include some survivorship and supportive care studies. But yes, we’re so excited about trastuzumab deruxtecan along with pertuzumab in patients with diagnosis of HER2-positive advanced breast cancer. That’s an amazing regimen. We’re seeing such really exciting results from the DESTINY-Breast09 study. So again, that’s a whole other area we could have talked about too. But yes, more and more we are seeing the power of these antibody-drug conjugates in the first-line setting.

(00:46:41):

But I loved, Jean, that you brought up that issue, that these drugs do have side effects. They’re not easy. Managing the side effects, the nausea, the blood counts, the liver function test abnormalities, hair loss. Does scalp cooling work well with them? These are all questions we’re going to have to get better at addressing for our patients.

Jean Sachs, MSS, MLSP (00:47:01):

Great. All right. I know there’s more questions, but let’s get to the quality of life and then hopefully we’ll have a few minutes to do more.

Amy Comander, MD, FACLM (00:47:08):

So this is an area of great interest to me. I’m being mindful of the time, but I was telling Jean, I was so excited this year to chair a session at ASCO focused on optimizing breast cancer survivorship with a focus on lifestyle changes, managing psychological health, and also weight management. And we had a wonderful patient advocate Laura Carfang with us too. It was amazing. So that’s why I really wanted to focus on a few of these studies and I’m going to go through them pretty quickly because I don’t want to use too much time.

(00:47:37):

I’m sure we have some yogis in the audience, so you’ll be happy to know that yoga was presented at the American Society of Clinical Oncology meeting, super exciting. So this was the YOCAS study really looking at yoga, mood disturbance, and insomnia in individuals with cancer. And this was a nationwide phase III randomized controlled trial. Super cool.

(00:48:00):

I don’t need to tell you that unfortunately mood disturbance, anxiety, fatigue, and insomnia are very prevalent among cancer survivors and certainly can affect quality of life. And so there was interest in seeing if a yoga intervention could help improve these particular symptoms. The aims of this study were to look at this yoga intervention specifically on mood disturbance, anxiety, and fatigue, and to determine whether improvements in mood disturbance, anxiety, and fatigue can also explain why this yoga intervention could be associated with improvements in insomnia, because we know that’s very prevalent as well.

(00:48:42):

Different types of yoga were used. I’m not an expert on different types of yoga. I do love yoga, but gentle hatha yoga, restorative yoga, different postures and components were assessed, but I love that there’s a yoga prescription. How cool is that?

(00:48:59):

Four weeks of yoga, two sessions a week, 75 minutes, opportunity to do it at home. It looks like it was quite standardized, and individuals got this kit. How fun is that? These were the eligibility criteria. Again, we always have to specify that in a trial to make sure we’re very consistent about who can participate in the trial. I will say it looks like they did exclude individuals with advanced cancer and certainly I think they made that decision, but of course I think that in a future study they should include individuals with advanced cancer because of course we want to study the benefits in all individuals. So this is the schema for the trial, a randomized controlled trial of yoga. And so it looks like half the individuals got the yoga intervention, half got standard of care, and then they were assessing these factors after the intervention.

(00:49:53):

And they were demonstrating that attendance was pretty good, 81%, and basically looking at the dose of yoga, love it, in terms of how many times a week people were doing it, et cetera. Really the key take-home point, which I think should not be a surprise to anyone who loves yoga, is that the intervention did result in improvement of mood disturbance, lower risk of anxiety, improvement in fatigue. The green reflects the individuals with yoga intervention, blue is standard of care. And so they concluded that this intervention was very effective focusing on these particular factors and also helped address insomnia, which is great. And so we as oncologists should talk about hatha yoga, restorative yoga for our patients and be familiar with yoga resources in our community. I love that. So I will definitely talk to my patients more about yoga. And these are the concluding points that the researchers shared about yoga.

(00:50:52):

If you’re already doing yoga, keep it up. If you haven’t tried it, maybe you should.

(00:50:57):

So that was really interesting. And then there was a group from Italy that talked about the Mediterranean diet and effect of an intervention using the Mediterranean diet, physical activity, and ensuring vitamin D levels were appropriate for individuals with breast cancer, specifically looking at risk for recurrence as well as cardiometabolic health. This was quite an undertaking to do in Italy, but amazing. I myself gave a presentation about lifestyle factors in breast cancer at ASCO. And I do love this slide because it really summarizes some of the key recommendations.

(00:51:32):

If you are looking for evidence-based lifestyle recommendations, the American Institute of Cancer Research, World Cancer Research Fund has this great figure. It says cancer prevention recommendations, but it’s very applicable to cancer survivorship as well. Great tips here. What does it mean to have a Mediterranean diet, a Mediterranean lifestyle? Sometimes you don’t know what that means. This is a really helpful figure here. And really highlighting what are some of the evidence-based interventions that have been shown to be helpful for breast cancer survivors.

(00:52:00):

Anyway, so let’s talk about this. They also highlighted that in Italy, their 5-year breast cancer survival rate is 88%, so of course they want to do better, and that’s why they did this intervention. Again, here we are, a randomized controlled trial, a different kind of randomized controlled trial. Do we have a low intensity treatment, which means traditional Mediterranean diet, counseling people to not sit too much, get their vitamin D around 30 versus the high intensity treatment, which was the traditional Mediterranean diet with a focus on low glycemic index carbohydrates. That means whole grains, things that are less likely to raise the blood sugar, encouraging folks to walk 30 minutes a day, and get their vitamin D up a little bit more.

(00:52:44):

They follow these individuals for about 33 months and they were looking at risk for breast cancer recurrence as well as looking at cardiometabolic risk factors. I know I’m going through this quickly, but I just want to make sure you understand what they were doing in this particular study. Here they have more information about what they mean by the Mediterranean diet, what they mean by low glycemic index foods, and some of the analyses that they were doing.

(00:53:10):

Just to give a quick summary of the conclusions. We do know that a poor diet, being physically inactive, low vitamin D, those are not good factors when we think about breast cancer outcome and cardiometabolic health overall. We do know there are so many benefits for eating a healthy plant-forward diet is the term I like to use. Here they focus on the Mediterranean diet, really focusing on more of a low glycemic index diet and also thinking about exercise, which we know is so important, vitamin D, making sure that’s appropriate. These are important for our cardiometabolic health, inflammation in the body, and potentially can affect breast cancer prognosis.

(00:53:54):

I will tell you in their study, they didn’t show a significant decreased risk of recurrence in the whole population, but particularly in the individuals with hormone receptor positive breast cancer, there did seem to be in their data potentially a sign of reduced risk of recurrence for those who are more adherent to these factors in two here in terms of the living getting Mediterranean diet exercise.

(00:54:21):

Very thought-provoking, interesting. Of course, I’m super interested in this area too. So really just more data to support the importance of lifestyle factors, focusing on a healthy dietary pattern, staying physically active. These are all important for our outcome. We think about the whole person, not just the drugs they’re taking.

(00:54:43):

I know I’m going fast, but we’ll have some time for discussion at the end.

(00:54:46):

Another hot topic. So we talked about yoga. We talked about diet and exercise and now I love this other tool that I have in my toolkit to help my patients with hot flashes. These very cool drugs you probably had heard of fezolinetant, or Veozah, which is the trade name, and maybe you have heard of elinzanetant. I know they’re so hard to say, also called Lynkuet.

(00:55:10):

This was an updated presentation of the OASIS-4 study specifically looking at this drug elinzanetant, which can help with hot flashes, but also can it help with sleep disturbance and quality of life in women with breast cancer who are having severe hot flashes.

(00:55:28):

This is something I talk about with my patients all day long in clinic, and we know that this is certainly a very common side effect, hot flashes and sleep disturbance. This class of drugs, they’re so cool. They’re working in the brain on the neurokinin receptors to help with thermoregulation and to reduce the experience of hot flashes.

(00:55:47):

We know in the OASIS-4 trial that use of this medication did result in significant improvement in vasomotor symptoms — sleep disturbance, quality of life — for individuals with breast cancer, but let’s specifically look at the sleep disturbance and quality of life. That’s what they did in this study. And they really did show that in addition to helping the hot flashes, elinzanetant did result in improvement in sleep compared to a placebo, which is amazing, regardless of what endocrine therapy they are on. Also they saw improvements, vasomotor symptoms, psychosocial aspects, physical aspects, sexual aspects of menopause-related quality of life. So this is amazing. It really supports use of this medication in our patients who are having severe symptoms related to menopause.

(00:56:32):

I call this a tool in the toolkit. Yes, sometimes in my clinic, I find there are issues with insurance coverage. Sometimes we need to start another medication first and see how the patient does. And if she doesn’t do well on it, we can make a case for elinzanetant. But again, super excited about this medication.

(00:56:49):

Jean, should I just do a quick overview? So again, another hot topic, which could be a whole other conversation. And I know, Jean, you are hosting a webinar about this soon, but I’ll just quickly say GLP-1s were hot at ASCO.

(00:57:05):

I included in my slides a few of the posters showing some of this exciting research that’s being done on GLP-1s. This is one looking at GLP-1 receptor agonists for prevention of postmastectomy, lymphedema and seeing this signal that it could be beneficial. This is one looking at outcomes for hormone receptor-positive breast cancer. Does it actually improve outcomes? Here’s one looking at how do patients who are on CDK 4/6 inhibitors and endocrine therapy. How do they do on these GLP-1 medications? Here’s one on does that reduce risk of breast cancer in the first place. Super exciting. This is another new field that is going to take off. I’m particularly very interested in this myself.

(00:57:45):

And I just want to say here’s a quick summary then we can talk about it. A lot of these are observational studies. So they’re looking at large databases and doing retrospective analyses. You can see these interesting associations, but we can’t totally prove causation at this time, but still very thought-provoking, very exciting. And certainly we think that maybe these drugs are doing more than just helping with glucose control. Maybe there’s some anti-inflammatory properties, maybe they’re modulating the immune system, other metabolic effects that could affect our tumor. Very cool. We need prospective studies. We need more research, randomized trials, like all the other studies I showed you, to truly prove the benefit.

(00:58:27):

As of today, I would still say that these medications should be used for the approved indications if someone has diabetes, obesity, or other factors that merit prescribing these medications. I would not prescribe them just for breast cancer at this time, but I do think this is an interesting evolving area that we are going to learn more about.

(00:58:45):

I’m going to stop talking so we have some time for questions.

Jean Sachs, MSS, MLSP (00:58:48):

All right. I think we have 7 minutes. So I’m going to try as fast as I can. I appreciate the studies, the quality of life studies. Let’s get insurance to pay for yoga and for healthy food. I think that’s really important.

(00:59:02):

In the exercise study, did they look at the difference between what kind of subtype you had?

Amy Comander, MD, FACLM (00:59:11):

Sorry if I’m making anyone, I’m going to stop doing that. It was making me dizzy too. So they did break it down. The benefit in this particular study was shown to be more beneficial for those with estrogen receptor-positive tumors. I will tell you the benefits of exercise are regardless of subtype. We have so much data on the benefits of physical activity for men and women with breast cancer.

(00:59:38):

I can quickly tell you the recommendations and I don’t want to overwhelm anyone. I know this is a lot: 150 minutes of moderate aerobic activity each week. You can divide that up however you would like. And I just want to put in a plug for doing your strength or resistance training at least twice a week. Someone asked about bone health earlier. This is what’s needed to help make our bone strong. Improve our muscle mass, improve our metabolic health. So investing in physical activity is such an important thing for all cancer patients.

Jean Sachs, MSS, MLSP (01:00:08):

Great. And I always get nervous when people get confused. So I do think with the onset of SERDs being used in the early stage, there is a question if someone had an oophorectomy, would a SERD be needed? So can you explain?

Amy Comander, MD, FACLM (01:00:26):

Great question. So let’s say when we get to that point. Let’s say, I’m going to make it up, in November we have the oral SERDs available for early-stage breast cancer. If a woman’s had an oophorectomy, she would still be a candidate for her adjuvant endocrine therapy. And if she was a candidate for a SERD, she could go on it and she would not need the Lupron or ovarian suppression because her ovaries were removed.

(01:00:52):

Removing the ovaries is an important intervention, but typically we also would recommend whether it’s tamoxifen or the aromatase inhibitor or potentially the giredestrant.

Jean Sachs, MSS, MLSP (01:01:02):

OK, great. This is not something you talked about, but there is a question about what about the latest on HLA-matched therapies like BriaCell-IMT clinical trial?

Amy Comander, MD, FACLM (01:01:15):

I know, so cool. And I have a patient going on one of these studies now myself. I am sure there was … I didn’t get to see the latest presentation specifically on that at ASCO, because as you can see, there was a lot and I’m still catching up myself, but certainly this harnessing our immune system to fight cancer through these vaccines or other immunotherapies is also such a hot topic, wave of the future, super exciting. And so if there is a trial at your institution for your type of breast cancer that is exploring the use of these therapies and you’re eligible, definitely look into it and check it out. It’s very exciting.

Jean Sachs, MSS, MLSP (01:01:55):

And I will say there’s a lot of people on this webinar who have been in trials and are actively in trials, so just want to thank you. That is the only way we’re going to make some progress here. I don’t know if you saw anything specific to lobular breast cancer either.

Amy Comander, MD, FACLM (01:02:13):

Oh yes, the Lobular Breast Cancer Alliance is another amazing nonprofit organization, and they had a whole session dedicated to lobular breast cancer. I happen to know the person who’s the executive director for that amazing nonprofit, and she sent me all the slides yesterday. So again, I was preparing this talk, so I haven’t had a chance to watch all of those or go through all the slides in depth, but there was a whole session. It may have been, I don’t want to say the wrong thing, but it may have been the first time at ASCO a whole session dedicated to lobular breast cancer. So super interesting, and I’m sorry, I don’t have all the updates from that, but I want you to know that an entire session at ASCO is dedicated to that and that organization is very much committed to funding more research specifically for lobular breast cancer.

(01:03:03):

So check it out, check out their website if you want to learn more.

Jean Sachs, MSS, MLSP (01:03:06):

And for those of you that don’t know, you can register for free as a patient advocate to watch all these sessions live. So you have to just send an email to them, and they’ll ask you a couple of questions. You have to prove you’re a patient or a patient advocate, but then you can get access to all the sessions. And it’s a great way to dig deep because obviously we can’t cover everything.

(01:03:33):

For the KEYNOTE-522 study, did you have to have the PD-L1?

Amy Comander, MD, FACLM (01:03:43):

So for KEYNOTE, great question. So for KEYNOTE-522, this is a really good question actually. In the early-stage setting, they did test it, but no, you do not have to have PD-L1 positivity in order to enroll on that study or be treated with that in our clinic today. If I saw a patient today, I would treat her with that if she’s early-stage, triple-negative and meets the criteria. Interestingly, for advanced triple-negative breast cancer, we are testing for it to determine if they would be a candidate for first-line therapy. Again, I mentioned as in ASCENT-04 for sacituzumab govitecan and pembrolizumab. So really interesting question.

(01:04:22):

Also, you could say the same thing about ESR1 mutations. So when we do get our giredestrant approved, would we test for an ESR1 mutation? We wouldn’t expect a person with early-stage breast cancer to have that. That’s something that unfortunately can evolve as a resistance mechanism as someone’s on therapy, but in advanced estrogen-sensitive breast cancer, we do test for it.

(01:04:44):

So these are really interesting questions that we’re just going to have to figure out as we do more research.

Jean Sachs, MSS, MLSP (01:04:49):

And was there anything about the triple-positive patients?

Amy Comander, MD, FACLM (01:04:54):

Yeah, so certainly there was a lot, of course, looking at our antibody-drug conjugates like Enhertu, trastuzumab deruxtecan, such an amazing game-changer drug. I see I’m just looking at the chat now. Sorry, guys, I usually am a multitasker.

Jean Sachs, MSS, MLSP (01:05:11):

No, no, don’t look at the chat.

Amy Comander, MD, FACLM (01:05:14):

I know! And I know there’s other antibody-drug conjugates that have been approved. Super exciting. I just want to convey the concept. This is a new field. How cool is this? We’re going to have more and more of these agents that are so effective for different types of breast cancer. And so I just want everyone to feel hopeful and excited about the way research is going, the field’s moving forward.

Jean Sachs, MSS, MLSP (01:05:34):

Yeah, I agree. And we’re going to have to wrap up.

(01:05:39):

I want to say that we do our best always to cover early stage and metastatic updates. We know it’s a lot, but Living Beyond Breast Cancer is always putting out information. So if you have questions, let us know. We’ll do our best to answer them. And we’ve talked a lot about these oral SERDs. I think one thing we don’t know yet is what they’re going to cost because we know the AIs are pretty inexpensive. I think as patients, that’s something to keep your eye out for once hopefully we have some of these approvals coming through.

(01:06:11):

All right, so we’re going to wrap up. I want to thank Dr. Comander for joining us. You did a great job. I hope you take a glass of water. Thank you for this rapid fire presentation. And also so soon after ASCO. Remember it was only really a week and a half ago that she probably returned. So we’re very, very grateful.