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ISOPT CONGRESS - JUNE 2026

Day One: International Summit on Breast Cancer

Jun 12, 2026 China
The 2026 International Summit on Breast Cancer convenes global experts to explore advances in breast cancer early detection, and multidisciplinary treatment of both early-stage and advanced-stage breast cancer. Through multidisciplinary discussion, the program focuses on translating emerging evidence into practical strategies that improve care and outcomes for patients worldwide.
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Updates in Systemic Treatment of Breast Cancer

ER+ Breast Cancer 18:28

ER+ Breast Cancer

Giuseppe Curigliano

For years we have asked whether a node-positive woman with ER-positive disease truly needs chemotherapy. Professor Giuseppe Curigliano opened his ASCO read-out with the abstract he and Profe...

For years we have asked whether a node-positive woman with ER-positive disease truly needs chemotherapy. Professor Giuseppe Curigliano opened his ASCO read-out with the abstract he and Professor Hope Rugo judged the most important of the meeting: OPTIMA. The trial used a 50-gene test to decide, and the answer it gave is more complicated than the headline suggests.

Curigliano walks through the year's HR-positive, HER2-negative data with a clinician's discipline: what the trial actually showed, where the numbers are solid, and where he is not yet willing to change practice. OPTIMA anchors the talk, followed by fast, honest updates across the early and metastatic settings, including one closely watched trial that missed its endpoint.

Key points for clinicians:

  • OPTIMA randomized 4,420 patients and used the Prosigna 50-gene (PAM50) test to direct chemotherapy in node-positive HR-positive, HER2-negative disease. Invasive breast cancer-free survival events were nearly identical between arms, 7.2 percent in the control arm and 7.3 percent in the test-directed arm, meeting non-inferiority. The authors concluded the test identifies a group with minimal chemotherapy benefit, at most two recurrences prevented per 100 patients.

  • Curigliano's caution is the point worth keeping: only 18 percent of OPTIMA patients had four to nine involved nodes, so he is not yet confident omitting chemotherapy in that group, and an academic trial incorporating CDK4/6 inhibitors is ongoing.

  • NATALEE, with longer follow-up, confirmed ribociclib's invasive disease-free survival benefit. A PAM50 analysis suggested the benefit extends across intrinsic subtypes, including HER2-enriched and basal-like, pointing to potential predictive value.

  • In advanced disease, the evERA data showed giredestrant plus everolimus delaying progression and chemotherapy in both ESR1-mutant and non-mutant patients, with an early overall survival trend.

  • VICTORIA-1 nearly doubled median progression-free survival in PIK3CA-mutant disease, from 5.6 to 11.1 months, with the gedatolisib, palbociclib and fulvestrant triplet, and stomatitis around 16 percent managed with prophylactic mouthwash.

  • persevERA, the first oral SERD trial in an endocrine-sensitive first-line metastatic population, did not meet its primary endpoint. Median progression-free survival was 33 months with giredestrant plus palbociclib versus 28 months with letrozole plus palbociclib, a hazard ratio of 0.89 that was not statistically significant. Curigliano ties the result to the endocrine-sensitive, largely ESR1 wild-type population enrolled. He closed with OASIS-4, where elinzanetant improved quality of life by controlling vasomotor symptoms during endocrine therapy.

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