James Crespo

Medical Oncologist | Breast Cancer Specialist

[Annals of Oncology @Annals_Oncology]

🔥The final outcomes of SOFT and TEXT are out in @Annals_Oncology
Ovarian function suppression (OFS) + tamoxifen ⬇️ recurrence risk compared to tamoxifen Further reduction in recurrence is seen with exemestane + OFS vs. tamoxifen
https://t.co/cpHhlv21vo

[Yukinori Ozaki, MD, Ph.D @YukinoriOzaki]

Overview of ASCO2026 Breast Cancer topics!! 🏖️ #ASCO26
@Ganken_hosp
@OncoAlert @JCOG_official
#BreastCancer #ASCO

[Giampaolo Bianchini @BianchiniGP]

🔥 More is not always the best

REDUCE trial demonstrated that every 12 weeks denosumab is not inferior to standard every 4 weeks

✅ Non inferior efficacy
✅ Improved safety profile
✅ Reduce cost

I love this type of trials!
Congratulations to all investigators

[James Crespo @JCrespoMD]

Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer | New England Journal of Medicine https://t.co/hDtQUMZTyh

[Yakup Ergün @dr_yakupergun]

#ASCO26

OPTIMA does not teach us a completely new biology; it reinforces the Oncotype DX-era message with Prosigna/PAM50 at a phase III level.

What makes it important is the population: clinically high-risk ER+/HER2− EBC, frequent nodal positivity, 19% pN2 disease, and 37% premenopausal patients. Yet 68% had low ROR scores, and chemotherapy omission was non-inferior for 5-year IBCFS.

Clinical risk ≠ genomic risk

‼️median follow-up is only 3.9 years, which is still early for HR+ disease.

[Luca Arecco, MD @Lucarecco]

Alongside #ASCO26, the new ESMO metastatic breast cancer guidelines have just been published in @Annals_Oncology

Congrats to all co-authors, and a special mention to @myESMO mentor @E_de_Azambuja for this well-deserved recognition! 👏🏼
@OncoAlert

Link: https://t.co/AlUMSY6iTZ

[Ilana Schlam @IlanaSchlam]

Happy to share our review on ctDNA in early breast cancer. We discuss current evidence, clinical applications, challenges, and future directions @stolaney1 @StefiMorganti @nlinmd @hthrparsons @DFCI_BreastOnc @JAMAOnc

https://t.co/ULtE0F7hJk

[Dr Rishabh Jain @DrRishabhOnco]

🚨 THE 15 MOST IMPORTANT TRIALS OF #ASCO26

May 29 - June 2 | Chicago
Which trial are you watching most closely?

🌟 PLENARY GAME-CHANGERS

1️⃣ PROTEUS
Perioperative apalutamide + ADT in high-risk localized prostate cancer

2️⃣ LIBRETTO-432
Adjuvant selpercatinib in RET+ NSCLC

3️⃣ HARMONi-6
Ivonescimab + chemo vs tislelizumab + chemo in squamous NSCLC

4️⃣ RASolute 302
Daraxonrasib (RMC-6236) in metastatic pancreatic cancer

5️⃣ SARC041
Abemaciclib in dedifferentiated liposarcoma

⚡ FRONTLINE & PERIOPERATIVE SHIFTS

6️⃣ KEYNOTE-B15 / EV-304
EV + pembrolizumab vs chemo in MIBC

7️⃣ LITESPARK-022
Pembrolizumab + belzutifan in adjuvant ccRCC

8️⃣ AMBITION
Paclitaxel/bevacizumab ± atezolizumab in HR+ breast cancer

9️⃣ NeoADAURA
Neoadjuvant osimertinib in EGFR+ NSCLC

🔟 A-DREAM
ADT interruption strategies in mCSPC

🧬 PRECISION, ADCs & NEXT-GEN IMMUNOLOGY

1️⃣1️⃣ DESTINY-Breast06
T-DXd expands into HER2-ultralow disease

1️⃣2️⃣ CROWN (7-year update)
Lorlatinib durability in ALK+ NSCLC

1️⃣3️⃣ DeLLphi-312
Tarlatamab in frontline SCLC

1️⃣4️⃣ COMMIT
Atezolizumab + FOLFOX/Bev in MSI-H mCRC

1️⃣5️⃣ IMvigor011
ctDNA-guided adjuvant atezolizumab in bladder cancer

#OncoTwitter #MedTwitter #ASCO26 #CancerResearch @OncoAlert @ASCO @JCOPO_ASCO @OncBrothers

[Kazuki Nozawa, MD @kazuki_nozawa]

A wonderful experience in Berlin.

Behind every trial is the persistent work of researchers striving to change the future of patients with cancer.
Deep respect to all who continue to move breast cancer care forward.

This is my overview #ESMOBreast26
@myESMO. @OncoAlert

[Rohit Malde @roxboxfix]

2nd Line Treatment Options in Mets Breast Cancer

Post Progression after AI + Cdk 4/6 inhibitors use in 1st Line

Mandatory = Organise NGS testing

See the Wonderful options

Trial evidence and Efficacy snd Salient Toxicity

[Dr Rishabh Jain @DrRishabhOnco]

🚨 FDA’s take on SERENA-6 is basically this:
“Nice data… but are we helping patients?”

Let’s break it down 👇

🧠 Problem 1: Wrong question

Trial asks:
👉 Switch early vs don’t switch

But real-world question is:
👉 Switch early vs switch later
FDA:
❌ “You didn’t answer the real question.”

⏱️ Problem 2: The PFS illusion

PFS looks great (16 vs 9.2 months)

But… it starts from:
👉 ESR1 mutation detection (not progression)

FDA:
❓ “What does this PFS even mean clinically?”

🧬 Problem 3: Biology mismatch

We assume: ESR1 mutation = resistance

FDA says:
👉 Not so fast

Patients may still benefit from AI + CDK4/6i
even AFTER mutation appears

👉 Early switch = stopping a working drug

🔁 Problem 4: No second chance

Control arm never got camizestrant later ❌

So we don’t know:
👉 Early vs delayed use

FDA:
❌ “This comparison is incomplete”

📉 Problem 5: Where is survival benefit?

OS = immature
Final data → years away

FDA:
👉 “Without OS, paradigm shift is risky”

⚠️ Problem 6: Not risk-free

QT prolongation
Bradycardia
Rare TdP

👉 Not a harmless switch

🎯 FDA’s real message:

“Just because we can act early…
doesn’t mean we should.”

🔖 Save this - this is how regulators think

📖 Full FDA briefing in comment ⬇️

#OncoTwitter #MedTwitter #BreastCancer #ESMOBreast26
@OncoAlert @myesmo @esmo_open @asco @OncBrothers

[Dr Amol Akhade @SuyogCancer]

What's New data in breast cancer at ASCO 2026 ?
Check this out 🙂👇 @ASCO #ASCO26

[CA: A Cancer Journal for Clinicians @CACancerJournal]

HR+/HER2- metastatic breast cancer is driven by diverse biology & evolving resistance. @DrDebuTripathy et al discuss precision treatment advances through targeted therapies, genomic profiling, & patient-centered decision making: https://t.co/DU86kXa5qB

@OncoAlert #BCSM #TNBCDay

[MV Chandrakanth @ChandrakanthMv]

• 21-gene assay in HR+/HER2– EBC
• TAILORx: Most N0 pts avoid chemo
• RxPONDER: Postmeno ≠ Premeno
• Age modifies benefit
• Biology > tumor size
#MVOnco #OncotypeDX #BreastCancer

[Paolo Tarantino @PTarantinoMD]

PATINA is now out in @nejm. Among pts with HR+/HER2+ MBC progression-free after chemo induction, adding palbociclib to 1L ET+HER2-blockade maintenance prolonged PFS from 29 mo to an astonishing 44 months (HR 0.75, p=0.02). Congrats @Otto_DFCI & coauthors! https://t.co/YoE3Pje9Be

[Dr Rishabh Jain @DrRishabhOnco]

HER2+ eBC: Do we still need carboplatin in neoadjuvant TCHP?
New phase III neoCARHP suggests: maybe not 👀

🧠 Core idea:
Taxane + trastuzumab + pertuzumab (THP) can achieve similar pCR to TCHP, with less toxicity.

🧪 Trial snapshot (stage II-III HER2+ early BC, n=774)
🟦 THP × 6 cycles (taxane + H + P)
🟥 TCHP × 6 cycles (taxane + carbo + H + P)

📌 Primary endpoint: pCR (noninferiority met)
✅ pCR 64.1% (THP) vs 65.9% (TCHP)
Δ -1.8%, OR 0.93, P(noninferiority)=0.0089

🧬 Subgroups stayed consistent
HR+ 👉 56% vs 59%
HR- 👉 78% vs 78%

⚠️ Safety win (biggest headline)
Grade 3-4 AEs: 20.7% (THP) vs 34.6% (TCHP)
Serious AEs: 1.3% vs 4.7%
Less anemia, N/V, neutropenia, thrombocytopenia with THP ✅

🎯 Clinical takeaway:
For lower or moderate-risk HER2+ disease, carboplatin-free THP may be a strong de-escalation strategy…
…but we still need EFS/OS maturity, especially for stage III.

🔖 Save this for tumor board debates.
📖 Full paper in comment ⬇️

#OncoTwitter #MedTwitter #BreastCancer #HER2positive
@OncoAlert @myesmo @esmo_open @ASCO

[Neil Vasan @NeilVasan]

2025 was a banner year for BC therapy across all subtypes. My take on the top practice changing trials:

1. DESTINY-Breast09 | ASCO 2025
1L HER2+ MBC: TDxD + P vs THP. Median PFS 40.7 vs 26.9 months; HR 0.56. Regimen FDA-approved.

2. lidERA | SABCS 2025
Adjuvant ER+ BC: Giredestrant vs standard ET. Improved iDFS, HR 0.70.

3. monarchE (OS update) | ESMO 2025
High-risk ER+ BC: Abema + ET vs ET improved OS; HR 0.84.

4. DESTINY-Breast05 | ESMO 2025
High-risk HER2+ BC with residual disease: TDxD vs T-DM1 improved iDFS.

5. NeoCARHP | ASCO 2025
Neoadjuvant HER2+ BC: Carbo-containing vs carbo-free chemo demonstrated noninferior pCR.

6. HER2CLIMB-05 | SABCS 2025
1L HER2+ MBC: Tucatinib + HP maintenance vs HP alone improved PFS

7. TROPION-Breast02 | ESMO 2025
1L PD-L1- mTNBC: Dato-DXd vs chemo improved OS (23.7 vs 18.7 mo, HR 0.79).

8. ASCENT-04 | ASCO 2025
1L PD-L1+ mTNBC: Saci + pembro vs chemo + pembro improved PFS.

9. ASCENT-03 | ESMO 2025
1L PD-L1- mTNBC: Saci vs chemo improved PFS.

10. VIKTORIA-1 | ESMO 2025
2L ER+ MBC, PIK3CA WT: Geda + palbo + fulv triplet and geda + fulv doublet vs fulv improved PFS.

11. SERENA-6 | ASCO 2025
1L ER+ MBC switch: ctDNA-detected ESR1 mut; switch to camizestrant + CDK4/6i improved PFS vs AI + CDK4/6i.

12. DESTINY-Breast11 | ESMO 2025
Neoadjuvant HER2+ BC: TDxD + THP vs ddAC/THP improved pCR.

@theNCI @SusanGKomen @METAvivor @BreastCancerOrg @LivingBeyondBC @BCRF @PIK3CApathbreak @NBCCStopBC @Perlmutter_CC #bcsm

[Dr Rishabh Jain @DrRishabhOnco]

🚨 HER2CLIMB 05 just made “maintenance” exciting in HER2+ MBC
#SABCS25

Finish THP induction, then instead of “wait and watch,” you lock in control with tucatinib plus HP in 1L maintenance.

✨ Big picture
💙 Median PFS: 24.9 vs 16.3 months
💙 Extra 8.6 months without progression
💙 HR 0.64 (0.51 to 0.79), p < 0.0001

🧬 Works in both HR negative and HR positive
🟦 HR negative
• PFS 24.9 vs 12.6 months
• HR 0.55 (0.40 to 0.76), p = 0.0002
• +12.3 months gain

🟧 HR positive
• PFS 25.0 vs 18.1 months
• HR 0.73 (0.55 to 0.98), p = 0.0389
• +6.9 months gain

😌 Toxicity that oncologists can live with
Mostly low grade diarrhea, nausea and mild LFT rise, no new scary signals.

💡 Clinic takeaway
Tucatinib plus HP in 1L maintenance turns a good THP responder into a long controller, buying extra chemo free time across HR subsets.

🔖 Save this for your next breast board

#OncoTwitter #MedTwitter #BreastCancer #HER2 @OncoAlert @myesmo @esmo_open @ASCO @SABCSSanAntonio

[Oscar Tahuahua @drtahuahua]

DESTINY-Breast05 makes one thing clear, at this pace, T-DXd is rapidly becoming the backbone across most HER2-positive disease settings.

It cut invasive recurrence from 12.5% to 6.2% (↓ 53% ) & raised 3-year IDFS from 83.7% to 92.4% in pts with residual high-risk disease. ILD (9.6%) is the one safety signal that still deserves close attention.
@OncoAlert https://t.co/pfdgRBGK9j

[Yakup Ergün @dr_yakupergun]

#SABCS25

We learned from the lidERA study that oral SERDs may also be used in the early-stage setting. We saw that, as monotherapy, they are superior to endocrine therapy. However, for their combination with CDK4/6 inhibitors—or for sequential use after 2–3 years of AI plus CDK4/6 therapy—we will need to wait for additional data. We also need to keep cost in mind: these are expensive drugs, and the target population is very large. I doubt that even the most developed countries can absorb such financial burdens.