What are your top takeaways in Breast Cancer from ASCO 2026?

• OPTIMA (phase III trial presented by Robert Stein): I think this trial was interesting in that, like Oncotype DX, it supports de-escalation of chemotherapy with lower-risk patients and included pre-menopausal as well as higher nodal burden patients.

• Omission of axillary dissection from the update...

1. VIKTORIA-1: A practice-changing abstract, in my opinion. PFS in CDK46-resistant disease that is PI3K-mutated doubled to 11.1 months from a well-known and standard 5.6 months with capivasertib or alpelisib. Assuming FDA approval for wild-type, this will likely become a standard of care in this secon...

• Very provocative presentation of the OPTIMA trial showing little chemotherapy benefit in patients 40 years of age or older with up to 9 positive lymph nodes who were found to have low genomic risk disease based on the Prosigna assay.
• SAK 96/12 Reduse trial showing similar reduction in skeletal-rela...

1. LidERA (adjuvant giredestrant)

The results for giredestrant in the adjuvant setting were impressive, hitting that 30% reduction in iDFS. It’s looking like a robust, better-tolerated alternative to standard endocrine therapy for our ER+/HER2- patients. I think this will quickly become a go-to for ...

In breast cancer, the emergence of ADCs into earlier and earlier settings is heartening and will be influential in the guidelines.

What is fairly clear is that:

1. With the more potent payloads and linkers, not much target is needed to get responses.
2. ADCs are clearly more potent than standard chemotherapy...

• OPTIMA: Will now use genomic assays for patients with more than 3 positive LNs and premenopausal women.
• ASCENT-04: More evidence for Trodelvy plus pembro in the front-line metastatic triple-negative setting.
• ASCENT-03: Similar to above but without pembro in patients who do not qualify for immunotherap...

• OPTIMA trial
• VIKTORIA-1 in PIK3CAmt
• PersevERA negative trial