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ESMO Congress 2026

October 23–27, 2026 · Madrid · 2949 items

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#BREASTCANCER

★★★

13 people · 18 posts

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Deep dive

The ESMO 2026 breast cancer session featured long-term or biomarker data from three endocrine therapy studies: extended adjuvant aromatase inhibition (NSABP B-42), head-to-head comparison of upfront versus sequential aromatase inhibitor strategies (GIM3 FATA), and a retrospective biomarker analysis of the oral selective estrogen receptor degrader combined with an mTOR inhibitor (evERA). Background literature characterizing cancer stem cell markers, epithelial-mesenchymal transition markers, and HER2 heterogeneity in circulating tumor cells (CTCs) [1][3][4], as well as methodological comparisons of CTC detection platforms [5][2], reflects the ongoing translational interest in liquid biopsy for tumor heterogeneity and resistance mechanisms, providing methodological context for the evERA analyses of ctDNA tumor fraction, ESR1 mutation subtypes, and TP53/PIK3CA co-mutation subgroups.

The 15-year follow-up of NSABP B-42 showed that extended letrozole significantly reduced distant recurrence versus placebo but did not translate into an overall survival benefit: absolute benefit 4.4% in node-positive patients, 1.6% in node-negative patients (not statistically significant); disease-free survival (DFS), breast cancer-free interval (BCFI), and distant recurrence-free survival (DR) all improved modestly but significantly, with no increase in osteoporotic fracture risk.

The final analysis of GIM3 FATA enrolled 3,697 postmenopausal HR+ early breast cancer patients comparing anastrozole, letrozole, and exemestane given upfront or after 2 years of tamoxifen: upfront versus switch showed no significant difference in DFS (HR 0.95, 95% CI 0.82–1.09) or OS (HR 0.88, 95% CI 0.74–1.06); 10-year DFS rates were 79.1% for anastrozole, 76.6% for letrozole, and 74.2% for exemestane (global p=0.028), with adjusted DFS HR for exemestane versus anastrozole of 1.23 (95% CI 1.04–1.46), indicating relatively inferior efficacy for exemestane; 10-year OS showed no significant difference across the three agents (p=0.25). The conclusion favors individualized choice based on tolerability, comorbidities, and cost.

The retrospective evERA biomarker analysis reported that the PFS benefit of giredestrant plus everolimus was maintained regardless of ctDNA tumor fraction, across ESR1 variants (Y537S HR 0.35), and in TP53-mutant/PIK3CA-mutant subgroups. Limitations: both B-42 and FATA are mature adjuvant trials with long follow-up that established DFS/DR benefits but failed to reach OS significance; evERA is an exploratory subgroup analysis from a phase 2 trial, underpowered for definitive conclusions, and the comparability between ctDNA and CTC detection platforms remains to be further validated.

References
  1. 1.Stem cell and epithelial-mesenchymal transition markers are frequently overexpressed in circulating tumor cells of metastatic breast cancer patients · Breast Cancer Res 2009
  2. 2.HER2 status of circulating tumor cells in patients with metastatic breast cancer: a prospective, multicenter trial · Breast Cancer Res Treat 2010
  3. 3.Expression of stem cell and epithelial-mesenchymal transition markers in primary breast cancer patients with circulating tumor cells · Breast Cancer Res 2012
  4. 4.Detection and characterization of circulating tumor cells in blood of primary breast cancer patients by RT-PCR and comparison to status of bone marrow disseminated cells · Breast Cancer Res 2009
  5. 5.Comparison of assay methods for detection of circulating tumor cells in metastatic breast cancer: AdnaGen AdnaTest BreastCancer Select/Detect™ versus Veridex CellSearch™ system · Int J Cancer 2012
  6. 6.Molecular profiling and predictive value of circulating tumor cells in patients with metastatic breast cancer: an option for monitoring response to breast cancer related therapies · Breast Cancer Res Treat 2009
Floor
  7. Gil Morgan, MD

    🔎 OncoAlert 4SIGHT | #ESMO26

    引用@

    OncoAlert 4Sight Abstracts to be Presented at #ESMO26 Retrospective Exploratory Biomarker Analyses From evERA Breast Cancer: A Phase III Trial of Giredestrant + Everolimus in Patients With Oestrogen Receptor-Positive, HER2-Negative Advanced Breast Cancer in the Post-CDK4/6 Inhibitor Setting 🎙️ Sara Tolaney @stolaney1 🔬 Exploratory biomarker analysis of phase III evERA (365 ctDNA-evaluable): giredestrant + everolimus vs SOC endocrine therapy + everolimus in post-CDK4/6i ER+, HER2– aBC. ➡️ PFS HR 0.52 (0.39–0.70) with cTF ≥1%; 0.61 (0.40–0.94) with cTF <1% ➡️ ESR1m: PFS HR 0.58 (D538) and 0.35 (Y537) ➡️ TP53m PFS HR 0.65 (0.45–0.93); PIK3CAm 0.55 (0.36–0.83) ✅ Giredestrant + everolimus maintained greater PFS benefit regardless of cTF status, with benefit across all ESR1 variants and poor prognostic subgroups. #BreastCancer (4Sight Made from Abstracts publicly available at the ESMO website) Pinging OncoAlert Breast Cancer Faculty @matteolambe @aftimosp @E_de_Azambuja @DrSGraff @ErikaHamilton9 @hoperugo @stolaney1 @BianchiniGP @aftimosp @kevinpunie @ElisaAgostinett @to_be_elizabeth @GaiaGriguolo @JankovicK @raalbany @JavierCortesMD @JaniceTNBCmets @Prof_Nadia_H @LoiSher @jamecancerdoc @Lucarecco @Dr_Oncologista @guiandri76

    Same topic #BREASTCANCER · 13 people586 views8 likes6 reposts0 replies
  8. Mirrors of Medicine

    We use AIs every day, but how often do we have long-term head-to-head data? GIM3-FATA at #ESMO26: upfront vs switch made no difference, while exemestane trailed anastrozole on DFS

    引用@

    OncoAlert 4Sight Abstracts to be Presented at #ESMO26 Final Analysis of the GIM3 FATA Trial: Treatment Schedule and Three Aromatase Inhibitors in Postmenopausal HR+ Early Breast Cancer @PietroDePlacido @antoniorusso_pa @delmastro_lucia @MicheleDelauren @fperrone62 🔬 Randomized trial (n=3697): 5 years of anastrozole, exemestane or letrozole, upfront or after 2 years of tamoxifen. Co-primary: DFS by schedule and by AI. ➡️ Upfront vs switch: DFS HR 0.95 (0.82–1.09); OS HR 0.88 (0.74–1.06) ➡️ 10-year DFS 79.1% anastrozole, 76.6% letrozole, 74.2% exemestane (global p=0.028) ➡️ Exemestane vs anastrozole: adjusted DFS HR 1.23 (1.04–1.46). 10-year OS across AIs: no statistically significant difference (p=0.25) ✅ No schedule superior; exemestane associated with worse DFS. Choice should be individualized by tolerability, comorbidities and cost. #BreastCancer 🎙️ Pietro De Placido 👥 Laura Arenare · Erica Pietroluongo · Giancarlo Bisagni · Maria Sarobba · Antonio Russo · Ferdinando Riccardi · Lucia Del Mastro · Antonio Pazzola · Francesco Cognetti · Jennifer Foglietta · Stefania Gori · Francesco Nuzzo · Adriano Gravina · Michelino De Laurentiis · Roberto Bianco · Grazia Arpino · Sabino De Placido · Ciro Gallo · Francesco Perrone (4Sight Made from Abstracts publicly available at the ESMO website) Pinging OncoAlert Breast Cancer Faculty @matteolambe @aftimosp @E_de_Azambuja @DrSGraff @ErikaHamilton9 @hoperugo @stolaney1 @BianchiniGP @aftimosp @kevinpunie @ElisaAgostinett @to_be_elizabeth @GaiaGriguolo @JankovicK @raalbany @JavierCortesMD @JaniceTNBCmets @Prof_Nadia_H @LoiSher @jamecancerdoc @Lucarecco @Dr_Oncologista

    Same topic #BREASTCANCER · 13 people444 views7 likes4 reposts0 replies
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