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City of Hope Intensive Course in Genomic Cancer Risk Assessment

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ISOPT CONGRESS - JUNE 2026

Day Two: ISOPT Annual Meeting

Jun 13, 2026 Hong Kong
The 2nd Annual ISOPT Congress features world-class speakers discussing: 1) initiatives to reduce cancer mortality in Europe, Korea, and China, 2) the global cancer burden; 3) advances in neoadjuvant therapies for lung, colorectal, breast, and melanoma,; 4) multidisciplinary management of gastrointestinal, breast, and lung cancers; 5) principles for cancer prevention and early detection of colorectal, gastric, and lung cancers, and 6) the cost-effectiveness of nasopharyngeal cancer prevention and early detection.
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Advances in Neoadjuvant Therapies for Primary Cancers

Advances in Neoadjuvant Therapy for HER2+ Breast Cancer 21:44

Advances in Neoadjuvant Therapy for HER2+ Breast Cancer

Hope S. Rugo

In early HER2-positive breast cancer, we have learned how to escalate for the poor responders. We still have not cracked how to safely give less to the excellent ones. Professor Hope Rugo ma...

In early HER2-positive breast cancer, we have learned how to escalate for the poor responders. We still have not cracked how to safely give less to the excellent ones. Professor Hope Rugo makes that unfinished problem the center of her talk.

Professor Rugo argues that neoadjuvant therapy is the right path for all but the smallest HER2-positive tumors, because response tells you who needs more and who might need less. She walks through the de-escalation question of whether carboplatin can come out, the escalation data now reshaping high-risk disease, and a wave of newer antibodies and biomarkers that point toward treatment guided by tumor biology and real-time response rather than a fixed recipe.

Key points for clinicians:

  • The de-escalation case for dropping carboplatin is real but unsettled. NeoCARH showed identical pCR from THP versus TCHP, yet used every-three-week taxane over 18 weeks with more toxicity, and COMPASS-HER2-pCR found THP alone gave only a 33 percent pCR in ER-positive, HER2-positive disease versus 64 percent in ER-negative disease.

  • DESTINY-Breast11, a 927-patient neoadjuvant trial powered for pCR, showed trastuzumab deruxtecan followed by THP produced the highest pCR and RCB 0 or 1 rates seen in any trial, including a 61 percent pCR in HR-positive disease after just 12 weeks of THP, while the T-DXd-alone arm was closed for lack of efficacy.

  • In the adjuvant setting, the DESTINY-Breast05 interim analysis in a higher-risk residual-disease population improved invasive disease-free survival by almost 9 percent, with a three-year IDFS hazard ratio of 0.47 and a signal toward fewer CNS events.

  • Interstitial lung disease remains the toxicity to respect. It was the lowest ever reported at 4.4 percent in DESTINY-Breast11 and about 9.6 percent any-grade in DESTINY-Breast05, concurrent radiation appeared safe, and the rare deaths traced to missed surveillance CT scans.
    Newer targeted approaches are pushing pCR higher, including the biparatopic antibodies zanidatamab and anbenitamab, tucatinib added to trastuzumab and pertuzumab, and PET-CT and ctDNA dynamics used to select and de-escalate, with early ctDNA clearance tracking with higher pCR.

  • The direction is individualized therapy driven by tumor biology and response, as in adaptively randomized trials like I-SPY 2.2, moving away from the cookbook approach that closed the T-DXd-alone arm.

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