Harold Burstein, MD, PhD, summarizes important breakthroughs presented at ESMO 2025 for all sub-types and stages of breast cancer.
Well, we've been discussing breast cancer highlights from the ESMO meeting in Berlin in 2025, and it really was a remarkable meeting with so many major phase three studies being put forward. It felt like breast cancer kind of owned the city for a few days. I think some of the key takeaways that I have first, as we were just discussing about the HER2 positive early stage disease, exciting to see where TDXD or trastuzumab direct can clearly. A very potent antibody drug conjugate is going to emerge as an important tool for reducing risk of recurrence in high risk patients. I think there's still questions to be asked about the optimal sequencing of the drug. Is it going to be better for preoperative therapy or to wait until the second line, if you will, setting of patients who have residual disease, which makes more rational sense, but clearly a drug that's going to find a role in that setting. For ER positive breast cancer, important studies for both metastatic and early stage disease in early stage durable findings from long term follow up showing that CDK46 inhibitors, abemacycllib and ribocyclib are associated with persistent reductions and recurrence risk and emerging signals of survival, particularly in. Higher risk groups of patients again. So in my mind that's premenopausal women and patients who have stage 3 disease. Important to note that many women who have stage 2 breast cancer may not need these drugs still, and it's going to be an important scientific project to figure out who does and who does not need to commit to these multiple years of therapy with this class of drugs. In the metastatic setting for ER positive breast cancer, the wave of antibody drug conjugate findings and emerging surges continues. There are going to be 4 drugs in each of those classes, at least in the marketplace before the next 12 to 24 months. So time for some opportunities for pragmatic trials to compare these head to head, to figure out which drugs really make most sense, to figure out which will be most tolerable, and how we can combine them with other treatments in this space such as. Therapy agents, which are important in many subsets of breast cancer, those are all leading clinical trials, projects, and there is a wave of these drugs still to come forward. There are literally hundreds of compounds because they're relatively easy for pharmaceutical and biotech companies to manufacture, and because of the complexity of the biocompound, they have very long patent half lives, so there's a lot of interest in working on these drugs and figuring out where you can capitalize on that efficacy. And finally we began by discussing about antibody drug conjugates in the setting of triple negative breast cancer. Clearly these are drugs that are transforming the natural history of that disease. What we saw were data from two studies looking at first line TNBC earlier in the year we've seen studies looking at first line treatment in combination with pembrolizumab for ADCs for triple negative breast cancer. There was PDL1 positive. So important questions still about the optimal sequencing of these drugs, whether they are active one after the other, but clearly a class of drugs here to stay. I hope you've enjoyed this presentation. We're trying to give you our hopefully thoughtful and well informed take on best use and best practices for these drugs. We look forward to talking to you again soon. Thank you very much.
