General Session 1

In this video, Dr Donatienne Taylor discusses and comments on the data of some interesting studies presented at the first general session at SABCS 2024. 

The EMBER-3 trial explored the use of imlunestrant, an oral selective estrogen receptor degrader (SERD), in HR+ positive metastatic breast cancer. Patients included in the study had previously received endocrine therapy, although the use of CDK4/6 inhibitors was not mandatory. Participants were randomised into three groups: imlunestrant alone, standard-of-care endocrine therapy (predominantly fulvestrant), or a combination of imlunestrant with abemaciclib. The primary endpoints were PFS comparisons across these groups. The results showed no significant difference in PFS between imlunestrant alone and fulvestrant in the overall population. However, in the ESR1-mutated subgroup, a small but statistically significant benefit was observed for imlunestrant, with a PFS of 5.5 months compared to 3.8 months with fulvestrant. The combination of imlunestrant with abemaciclib demonstrated a significant improvement in PFS by four months compared to imlunestrant alone, with benefits consistent across various subgroups, including ESR1-mutated, PIK3CA-mutated, and those who had previously used CDK4/6 inhibitors. Safety data revealed that imlunestrant was well-tolerated, with manageable side effects such as mild nausea, diarrhoea, and fatigue. These findings mark the second positive trial for SERDs in the metastatic HR+ breast cancer setting, offering valuable insights for future therapeutic strategies.

The German PRO B trial investigated the role of frequent patient-reported outcome (PRO) surveys in patients undergoing treatment for metastatic breast cancer, with half of the participants receiving chemotherapy. Patients in the intervention group completed weekly surveys, which included alerts for clinician follow-ups, while the control group completed surveys only every three months. Results showed a clinically meaningful and statistically significant reduction in fatigue at six months, an effect that persisted at nine and twelve months. Moreover, a survival benefit was observed in the intervention arm, although the mechanisms underlying this improvement, such as potential treatment adjustments in response to alerts, remain unclear. These findings highlight the potential of PRO-based interventions to enhance the quality of life and survival outcomes in metastatic breast cancer patients.

A retrospective cohort study presented by Matteo Lambertini focused on BRCA1/2 mutation carriers under 40 years of age who had previously been diagnosed with stage 1–3 breast cancer. The study aimed to assess whether risk-reducing mastectomy or salpingo-oophorectomy influenced survival outcomes. Data from 5,290 patients revealed that risk-reducing mastectomy was associated with improvements in overall survival, disease-free survival and a reduced risk of secondary breast cancer. Similarly, salpingo-oophorectomy showed benefits in overall survival, disease-free survival, and breast cancer-specific survival. These findings provide robust evidence supporting the role of risk-reducing surgeries in improving survival outcomes for young BRCA mutation carriers who have already experienced breast cancer.

An update on the OlympiA trial provided a ten-year analysis with a six-year follow-up on the use of olaparib in the adjuvant setting for patients with high-risk HR+ or triple-negative breast cancer and BRCA1/2 mutations. The results reaffirmed the benefits of olaparib, showing a sustained improvement in invasive disease-free survival, which increased by 9.4%. Overall survival also improved by 4.4%. Importantly, no new safety concerns were identified, including risks of secondary malignancies such as acute myeloid leukaemia or myelodysplastic syndrome. Interestingly, the data suggested that olaparib might have preventive effects on developing new cancers, with fewer malignancies observed in the treatment group. These findings underscore olaparib’s long-term efficacy and safety, reinforcing its importance as a standard adjuvant therapy in this high-risk population.