Oncology Brothers: Practice-Changing Cancer Discussions Breast Cancer ESMO 2025 Highlights: MonarchE, NATALEE, VIKTORIA1, evERA, DESTINY, ASCENT, TROPION
Oct 30, 2025
Dr. Virginia Kaklamani, a breast medical oncologist from UT San Antonio specializing in clinical trials, shares crucial insights on ESMO 2025 breast cancer data. She discusses breakthrough findings from the MonarchE and NATALEE studies, emphasizing the overall survival benefits of abemaciclib. The conversation dives into the VIKTORIA1 trial results for metastatic HR+ disease and examines the promising efficacy of TDXd in HER2+ breast cancer settings. Kaklamani also addresses treatment strategies for triple negative breast cancer, offering community oncologists practical takeaways.
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Adjuvant Abemaciclib Shows OS Benefit
- MonarchE now shows an overall survival benefit with adjuvant abemaciclib in high-risk HR+ early breast cancer.
- The absolute OS gain is small (~1.8 months) but confirms CDK4/6 inhibitors change long-term outcomes.
Use Dose Escalation To Reduce Diarrhea
- Start abemaciclib with a dose-escalation strategy (eg, 100 mg then 150 mg) to reduce diarrhea risk.
- If intolerant, switch to ribociclib and complete three years per NATALEE.
Gedatolisib Shows Large PFS Gain
- VIKTORIA1 (gedatolisib) produced a striking PFS benefit with a very low hazard ratio in CDK4/6-pretreated patients.
- The drug is IV and causes frequent stomatitis, so prophylactic steroid mouthwash is likely needed.