One major highlight is the study by the name of ASCENT-04. In this study, the findings showed that during ADC therapy in combination with pembrolizumab as firs- line therapy was actually associated with significantly longer progression-free survival, compared to traditional chemotherapy and pembrolizumab. The agent sacituzumab, which we normally use in the second-line setting, was tested in the upfront  PD-L1 positive metastatic triple negative setting, and this was associated with improvement in progression-free survival of over 11 months, which is very clinically meaningful given that this is a very aggressive disease. We believe that this will likely lead to accelerated approval of changing the first line standard of care in metastatic triple negative breast cancer. I think that was an extremely important study that was discussed.

In terms of HER2 positive disease, the DESTINY-09 study was presented at ASCO this year, and this again was moving the trastuzumab deruxtecan which we currently give in the second line metastatic HER2 positive setting to the first line setting. Again, what we see is when we move up the ADCs to first line, we’re actually seeing significant improvement in progression free survival and here, patients had prolongation of progression free survival to over 40 months, which is again very clinically meaningful. But how we’re actually going to execute this in the real world after approval, I think we need to be thoughtful that receiving T-DXd indefinitely until progression can be hard in terms of toxicity and other complications. So I think what’s going to happen is that there will be additional clinical trials looking at perhaps an induction period followed by a maintenance period and incorporating additional targeted therapies like CDK4/6 inhibitors and endocrine therapy for patients who have hormone receptor-positive and HER2 positive disease. A lot of that we’ll obviously need to study before we can execute, but I think based on the findings it’s very much likely that  T-DXd will move up the line as the preferred first line of therapy in metastatic HER2 positive disease. So that was one additional exciting highlight.

Then in hormone receptor-positive breast cancer there were a number of updates looking at different targeted therapies, including the first time that a PROTAC, vepdegestrant, in the VERITAC-2 study was evaluated in a phase III setting, showing that, compared to fulvestrant, it had promising progression free survival. Again, we have a number of agents in the second line setting after progression on CDK4/6 inhibitors, so there’s going to be a lot of discussion in terms of how we sequence these agents, what agents we pick, but the takeaway was that there are a number of active targeted therapies after CDK4/6 inhibitor progression. Additional sequencing studies are needed for us to fully know how to utilise which agent over another.

Lots of exciting data with circulating tumour DNA, showing the prognostic relevance and ctDNA clearance being a very promising biomarker that will be further incorporated in clinical trials and I think that will have relevance across all subtypes of breast cancer.

Is there anything else you would like to add?

I think a theme that continued to come up during all the presentations was the importance of shared decision making, and really involving our patients in discussion of quality of life issues and toxicity issues. I think that’s an important thing to take back to our clinics which is that even the shinier, newer drugs can still have a number of significant toxicities, so informing our patients and focusing on optimal symptom management and supportive care is a very key component of optimising care.