Omar Peña Curiel

Breast/Gyn Medical Oncologist @HospZambranoTec, @ASCO member, 🇲🇽 certified

[Omar Peña Curiel @OmarOnco]

(Not) Very surprised on how we are immersed in a life around work and oftentimes forget there is actually scientific evidence to pursue not working at all 🤭 (from time to time).

Caroline Schenkel, MSc et all.

Oncologists in 2023 are experiencing higher rates of burnout compared with a decade ago. System-based interventions to reduce burnout are necessary to maintaining an adequate workforce to provide care for current and future patients with cancer.

[Omar Peña Curiel @OmarOnco]

VIKTORIA-1 #ASCO26: gedatolisib (PI3K/mTOR) crushes alpelisib+fulv in PIK3CA-mut, post-CDK4/6i HR+ mBC 💥
But look closer 👀
🟣 Triplet (geda + PALBO + fulv): 11.1 mo, HR 0.50
🟠 Doublet (geda + fulv, NO palbo): 11.3 mo, HR 0.51 (not powered but robust)

🥲 Adding palbo bought… nothing. Once again, palbo doesn't add up 🤷
@OncoAlert @Daniela_13vj @Dra_CVillarreal @Dr_Zamudio @Lalo_rey_90 @DrHectorDiaz @BrizioMoreno

[Omar Peña Curiel @OmarOnco]

Another underwhelming readout on a palbociclib backbone 🥲📉
⭐️persevERA #ASCO26: giredestrant + palbo vs letrozole + palbo → PFS 33.1 vs 28.2 mo 📊, HR 0.89, p=0.16 (NS) ❌

My take: Palbo is the best-tolerated CDK4/6i 🤝😌 ≠ strongest 💪
@Daniela_13vj @Dra_CVillarreal @Dr_Zamudio @Lalo_rey_90 @DrHectorDiaz @BrizioMoreno @OncoAlert
#breastcancer

[Omar Peña Curiel @OmarOnco]

At the end of the day 🌞, even though (statistically) we cannot state OS surrogacy, we STILL can advocate for 2️⃣ solid treatment options in 1L-non-IO candidate #TNBC patients.

IMO, toxicity / patient preference will lead the decision.
#TNBC #ASCO2026 @Daniela_13vj @Dra_CVillarreal @Dr_Zamudio @Lalo_rey_90 @DrHectorDiaz

[Omar Peña Curiel @OmarOnco]

⭐️Same setting (1L IO-ineligible mTNBC), 2 TROP2 ADCs:
🟢 Dato-DXd / TROPION-Breast02: OS benefit, HR 0.79
🔴 SG / ASCENT-03: no OS win → now leaning on PFS2
Yet statistician M. Regan #ASCO26 calls PFS2 here "misnamed" & not an OS surrogate. Crossover isn't a free pass for a soft endpoint 🎯
@Daniela_13vj @OncoAlert @Dra_CVillarreal #TNBC

[Omar Peña Curiel @OmarOnco]

Les dije que se esperaran 😜😜😜

[Omar Peña Curiel @OmarOnco]

@EuphrosMD @OncoAlert @OncBrothers I know, right⁉️ totally my favorite way of presenting data 🫡

[Omar Peña Curiel @OmarOnco]

🔥 Hot take (apparently): beginning the presentations with the conclusions instead of burying them at the end

Give me the takeaways, then show me how you got there. #ASCO26 is doing this right 📊➡️✅ @OncoAlert @OncBrothers

[Omar Peña Curiel @OmarOnco]

I concur 🫡: once again biology > size

[Nancy Lin, MD @nlinmd]

OPTIMA:
N=4429
Age 40+
ER >10%
0-9 nodes (19% N2)
37% premen - all received OFS

➡️ No diff in invasive events in control (chemo-ET for all) vs prosigna directed tx allocation (~2/3 of pts spared chemo)

➡️ No meaningful benefit of chemo in ROR<60 including premen or N2 subsets

[Nancy Lin, MD @nlinmd]

OPTIMA:
N=4429
Age 40+
ER >10%
0-9 nodes (19% N2)
37% premen - all received OFS

➡️ No diff in invasive events in control (chemo-ET for all) vs prosigna directed tx allocation (~2/3 of pts spared chemo)

➡️ No meaningful benefit of chemo in ROR<60 including premen or N2 subsets

[Dr Sarah Sammons @drsarahsam]

Dr Piccart reinforces that OPTIMA for the first time prospectively shows the chemo benefit for premenopausal low GEP women, is mostly due to chemotherapy induced ovarian suppression.

[Erika Hamilton, MD, FASCO @ErikaHamilton9]

Agree- this is the takeaway.

Previously, the 🙋‍♀️ has been how much of the premeno chemo benefit was chemo itself and how much was chemo-induced ovarian failure?

#OPTIMA mandated OFS, so eliminated this variable and suggests that the OFS was the majority of benefit.

#ASCO26

[Omar Peña Curiel @OmarOnco]

🧬 PARP inhibitors in mTNBC — the eligible pool widening is prime-time? (Nanda, #ASCO26):
Beyond gBRCAm ➡️ also gPALB2m and sBRCAm.
To my knowledge, only TBCRC 048 data and anecdotal (good response in my personal anecdotes😅)
@OncoAlert #TNBC

[Omar Peña Curiel @OmarOnco]

@PTarantinoMD The delta would be the same regardless 🤔, it does throw you off but the data remains the same.

[Omar Peña Curiel @OmarOnco]

❓How much are we over-treating T1a/b TNBC

🫰🏼Loved this framework from Leon-Ferre #ASCO26: a roadmap to (try) stopping treating all Stage I TNBC the same.
➡️Current: size + response decide everything.
➡️Future: TILs, gene signatures, ctDNA, imaging dynamic response → de-escalate the ultra-low risk, "rescue" the under-responders. 🎯
Biology > tumor size 🧬

[Stephanie Graff, MD, FACP, FASCO @DrSGraff]

Having seen the #ASCO26 OPTIMA data, in clinic, will you—

[Omar Peña Curiel @OmarOnco]

💊✂️ Neo-Healer (Shao et al., #ASCO26): one more reason to drop carboplatin in HER2+ neoadjuvant.
Anbenitamab (HER2 bispecific) + nab-docetaxel beat THP: 📊 pCR 62.4% vs 51.2% (Δ11.4%, p=0.0036)🔥 ER−: 76.3% vs 59.5%

Benefit held WITH or WITHOUT carbo. If the backbone delivers, why keep the tox? 🤔
@daniela_13vj #bcsm #HER2

[Omar Peña Curiel @OmarOnco]

🚨 7 years later, KEYNOTE-522 doesn't budge 💪
High-risk TNBC
📈 EFS 78.3% vs 69.8% · HR 0.68 · NNT 12
Durable benefit. Perioperative pembro = SoC 🎀
@OncoAlert @Dra_CVillarreal #ASCO26 #bcsm