SABCS 2024 Top Abstracts

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During the 2024 San Antonio Breast Cancer Symposium (SABCS), exciting and important results from many studies will be reported. In this conference preview commentary, breast oncology experts Joyce O’Shaughnessy, MD, and Heather McArthur, MD, MPH, highlight the abstracts they are most looking forward to seeing presented at the meeting, some with the potential to change the current treatment landscape of patients with breast cancer.

We will cover these abstracts in more detail as part of the Clinical Care Options (CCO) Independent Conference Coverage of SABCS 2024. Remember to check the CCO website often as the meeting unfolds to check for downloadable slidesets summarizing the data from these studies and more. After the conference, review the CME-certified expert analysis text module with perspectives and clinical implications of these new data.

Top Picks
The following abstracts are highly anticipated by the experts:

PADMA primary results: This prospective, randomized phase III study is investigating the efficacy of first-line endocrine therapy (ET) plus palbociclib compared with physician’s choice of monochemotherapy in patients with chemotherapy-indicated high-risk hormone receptor (HR)–positive/HER2-negative metastatic breast cancer (MBC) (Abstract LB1-03). The goal of this study is to assess whether adding palbociclib to ET can significantly prolong time to treatment failure compared with the standard-of-care chemotherapy regimens. Data to be presented at SABCS will show how the combination arm compared with single-agent chemotherapy regarding time to treatment failure (primary endpoint) and secondary endpoints including progression-free survival (PFS) and overall survival (OS).
First results from EMBER-3: A multicenter, randomized phase III study designed to evaluate imlunestrant, an oral selective estrogen receptor degrader (SERD), with or without abemaciclib compared with physician’s choice of ET in patients with estrogen receptor (ER)–positive/HER2-negative locally advanced or metastatic breast cancer who were previously treated with ET with or without a CDK4/6 inhibitor (Abstract GS1-01).
ELEVATE trial update: A phase Ib/II umbrella study of elacestrant combinations in patients with ER-positive/HER2-negative locally advanced or metastatic breast cancer (Abstract PS7-06). Previous press releases on this study noted elacestrant in combination with drugs such as abemaciclib, capivasertib, and everolimus was well tolerated, and the adverse events observed were consistent with the known safety profiles of the individual drugs. Safety and preliminary efficacy data of elacestrant combinations with either everolimus, ribociclib, or palbociclib will be reported at SABCS 2024.
Subgroup analyses from phase II RIGHT Choice clinical trial: First-line treatment with ribociclib plus ET compared with combination chemotherapy for pre/perimenopausal women with clinically aggressive HR-positive/HER2-negative advanced breast cancer—analyses by intrinsic subtype and gene-signature expression (Abstract PS2-06). Final results in the full analysis set showed that first-line ribociclib plus ET yielded significant PFS benefit, with similar response rates and better tolerability compared with combination chemotherapy in this patient population. Data to be reported at SABCS 2024 will show exploratory results with ribociclib plus ET compared with combination chemotherapy for those with luminal B/HER2-enriched intrinsic subtypes known to be associated with poor prognosis as well as other subgroups defined by gene and signature expression.
Phase I SERENA-1 study: Results from parts K/L of the next-generation oral SERD camizestrant (AZD9833) in combination with ribociclib in women with ER-positive/HER2-negatvie advanced breast cancer, including premenopausal women required to receive ovarian function suppression therapy (Abstract PS7-08). Data to be presented at SABCS 2024 will report on the impact of the combination on the pharmacokinetics of each agent and levels of ESR1-mutant circulating tumor DNA. The combination will be further explored in the ongoing phase III SERENA-6 trial. Updated results will be presented at the meeting.
DESTINY-Breast06 analyses by pace of disease progression to previous ET: This phase III study is evaluating trastuzumab deruxtecan (T-DXd) compared with physician’s choice of chemotherapy in patients with HR-positive/HER2-low (defined as IHC 1+ or 2+/ISH-) or HER2-ultralow (defined as IHC 0 with membrane staining; IHC >0 to <1+) MBC following previous treatment with ET (Abstract LB1-04). In a previous report, T-DXd demonstrated clinically meaningful and statistically significant improvement in PFS for patients with HER2-low and HER2-ultralow MBC after 1 or more previous treatments. Data to be presented at SABCS 2024 will report the efficacy of T-DXd compared with physician’s choice of chemotherapy according to pace of disease progression on previous ET.
Phase III KEYNOTE-522: A report of exploratory biomarker analyses for neoadjuvant chemotherapy plus pembrolizumab, an anti–PD-1 checkpoint inhibitor, or placebo followed by adjuvant pembrolizumab or placebo in patients with previously untreated stage II/III early-stage triple-negative breast cancer (TNBC) (Abstract LB1-07). Earlier results from this study showed a higher proportion of pathologic complete responses (pCR) in patients receiving chemotherapy plus pembrolizumab compared with chemotherapy plus placebo, leading to FDA approval in this setting. At SABCS 2024, we will also see data reporting OS and other subgroup analyses for this study with the potential for informing the design of future studies involving the use of immunotherapy (Abstract PS12-09).
NSABP B-59/GBG-96-GeparDouze: A global, double-blind, randomized phase III trial evaluating neoadjuvant chemotherapy (weekly paclitaxel and carboplatin every 3 weeks) with or without atezolizumab, an anti–PD-L1 checkpoint inhibitor, every 3 weeks for 4 cycles followed by adjuvant atezolizumab or placebo every 3 weeks for 12 months in patients with stage II/III TNBC (Abstract GS3-05). The coprimary endpoints of this study are event-free survival (EFS) and pCR rates. A report from this study to be presented at SABCS 2024 will include data for the coprimary endpoint of EFS after a median follow-up of 44 months.

Additional studies of interest include:

Phase III NATALEE: A report on the effect of ribociclib dose reduction on treatment efficacy in patients with HR-positive/HER2-negative early breast cancer (EBC)(Abstract P1-11-16).
Phase III NATALEE: A report on distant disease-free survival in key subgroups of patients with HR-positive/HER2-negative EBC treated with ribociclib plus a nonsteroidal aromatase inhibitor (Abstract P4-09-22).
Analysis of real-world data for risk of recurrence based on nodal status and high-risk features in patients with HR-positive/HER2-negative EBC (Abstract P1-11-02).
Randomized phase II SOLTI VALENTINE primary results: A study evaluating neoadjuvant patritumab deruxtecan with or without letrozole for patients with high-risk HR-positive/HER2-negative EBC (Abstract LB1-06).
Long-term follow-up from phase III OlympiA: A randomized, multicenter, placebo-controlled study evaluating adjuvant olaparib after (neo)adjuvant chemotherapy in patients with high-risk, HER2-negative breast cancer harboring germline BRCA1/2 pathogenic variants (Abstract GS1-09).
A study evaluating the combination of elacestrant with abemaciclib in patients with ER-positive/HER2-negative advanced or metastatic breast cancer (Abstract PS7-07).
neoHIP: Phase II trial of neoadjuvant HER2-targeted therapy with or without immunotherapy with pembrolizumab (Abstract RF3-05). The primary endpoint of this study is pCR rates.

Remember to Check the CCO Website Often During and After SABCS 2024!
Downloadable slideset summaries of many of these key studies will be available on the CCO website as the data are released. After SABCS 2024, comprehensive analyses by the expert faculty will explore the clinical implications of these data in a CME-certified text-based module.

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An Expert’s Guide to SABCS 2024: A Preview of the Top Abstracts

Heather McArthur, MD, MPH

Joyce O'Shaughnessy, MD

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