Oncology Brothers: Practice-Changing Cancer Discussions Metastatic HR+ Breast Cancer SABCS 2025 Highlights: Dr. Hope Rugo
Dec 26, 2025
Dr. Hope Rugo, a leading breast medical oncologist from City of Hope, shares her expert insights on metastatic hormone receptor-positive breast cancer, highlighting key findings from the SABCS 2025 conference. She discusses the superiority of CDK4-6 inhibitors over chemotherapy, strategies for choosing effective treatments, and the significance of ongoing clinical trials like SERENA-6 and VIKTORIA-1. Dr. Rugo also addresses the implications of recent studies on antibody-drug conjugates, offering essential clinical tips for treatment selection and toxicity management.
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CDK4/6 Beats Chemotherapy Frontline
- Multiple randomized trials show CDK4/6 inhibitors plus endocrine therapy outperform chemotherapy even in high tumor burden disease.
- Time to response is similar, so chemo is rarely necessary up front for HR+ metastatic patients.
Choose CDK4/6 By Patient Traits
- Start ribociclib for most first-line HR+ patients due to survival data across settings including premenopausal patients.
- Use palbociclib for older patients or those with cardiac/QT concerns, and consider abemaciclib if marrow suppression or liver enzyme issues occur.
ESR1 Detection Doesn't Mandate Immediate Switch
- Switching therapy at detection of an ESR1 mutation (before radiographic progression) prolonged time on next therapy but PFS2 interpretation is complex.
- Waiting until clinical or radiographic progression remains reasonable pending FDA and sequencing data.