Highlights on breast cancer 2

Dr Luca Arecco, a medical oncologist at the University of Genova (Italy) and the Institut Jules Bordet (Belgium), presents four trials from the oral abstract session on the adjuvant early setting of breast cancer at ASCO 2024.

The first two trials focus on early-stage triple-negative breast cancer.

The A-BRAVE trial investigated the use of avelumab following neoadjuvant chemotherapy or primary surgery and adjuvant chemotherapy, compared to observation. The primary endpoint was DFS, with secondary endpoints including efficacy, safety, and OS. Although the primary endpoint was not met, there was a significant increase in OS for patients who received avelumab compared to those who did not.

The PEARLY trial randomized patients with high-risk triple-negative breast cancer to receive carboplatin in addition to standard adjuvant or neoadjuvant chemotherapy. Patients with stage 2 or stage 3 disease were included, and the addition of carboplatin showed an improvement in EFS with a median follow-up of 51.1 months, showing a 7.8% improvement. These results confirm the value of carboplatin in treating triple-negative breast cancer, offering a significant prognostic benefit.

The RxPONDER trial assessed biomarkers to identify premenopausal patients with HR+/HER2-, node-positive breast cancer who would benefit more from adding chemotherapy to adjuvant ET. Hormones including estradiol, progesterone, inhibin B, and AMH were analyzed. The results demonstrated that patients with lower AMH levels, an indirect marker of ovarian reserve, did not benefit from adding chemotherapy to ET.

Biomarker analysis of the MonarchE trial, which involved patients with high-risk HR+/HER2- early breast cancer receiving two years of adjuvant abemaciclib in addition to standard endocrine therapy, showed that patients with ctDNA positivity had a worse prognosis compared to those with ctDNA-negative baselines. Thus, ctDNA detection is highly predictive of worse outcomes.