Abi Siva MD

EVERA PRO’s were presented today at #ESMOBreast26 Dex mouth rinse was recommended to all patients. Somatic rates below: W and WO prophylaxis. https://t.co/66Q57Z3D8m

evERA BC safety/QoL update: • Giredestrant + everolimus remained well tolerated • Steroid mouthwash prophylaxis delayed/reduced grade ≥2 stomatitis • Most pneumonitis events were low grade and reversible • No meaningful added toxicity from the oral SERD • HRQoL https://t.co/YUFPD6HglL

evERA safety update: #BREASTBreast26 Pneumonitis with giredestrant + everolimus: • Any grade: 24.2% • Grade 1–2: 19.8% • Grade 3–4: 4.4% • 77.8% resolved Stomatitis story important: • Dexamethasone mouthwash prophylaxis reduced grade ≥2 stomatitis (16.2% vs 25.3%)

I agree with @Dr_RShatsky and @dr_yakupergun in deciding which ADC to use in the residual disease setting port TDXD If there is no response to T-DXd and we suspect that the disease is being driven by an aggressive TNBC-like phenotype, this would be one of the few scenarios in which I would even consider adjuvant AC, which I otherwise rarely use in the Her2+ setting. On the other hand, if ER-positive luminal biology is driving the disease, which is not uncommon, I would love to see future trials incorporating SERDs and CDK4/6 inhibitors into the triple-positive adjuvant setting, particularly as we continue to learn more about the role of endocrine-based strategies in Her2+ from studies such as PATINA. Neratinib is an established option here as well, for extended Her2 blockade.

Latest @NCCN update now supports palbociclib maintenance per PATINA. Many of us have already been doing this in practice, and this should help with insurance approvals. @ASCO @SABCSSanAntonio @OncBrothers @PTarantinoMD https://t.co/FgfjvtBzRD

The OPTIMA trial answered some important questions about personalizing adjuvant therapy in ER+ breast cancer. Here’s my take on what the findings mean for clinical practice. #ASCO26 @muschollings https://t.co/ubYCcE0WFM

Optima trial showed shows PAM 50 based chemotherapy selection is non inferior to standard chemo. Limitations: short follow up time-3.9 years, N2 patients were about 19%. https://t.co/Z4kO5dguS3

CAPItello-291 OS update presented @hoperugo #ESMOBreast26 Fulvestrant + capivasertib vs fulvestrant alone in ER+/HER2− advanced breast cancer after endocrine therapy. Key population: • ~70% prior CDK4/6 inhibitor • ~40% endocrine-resistant disease • Second-line and beyond https://t.co/XmXZBPKIl5

CAPItello-291 final analysis: #ESMOBreast26 • Capivasertib + fulvestrant maintained clinically meaningful PFS benefit in both overall and AKT pathway–altered populations • OS showed a numerical trend favoring capivasertib (HR 0.83 in altered group), but was not statistically

Updates from HER2CLIMB-05: Tucatinib + HP Maintenance Significantly Extended PFS After THP Induction in 1L HER2+ Metastatic Breast Cancer #ASCO26 • Tucatinib + maintenance HP improved median PFS: 24.9 vs 16.3 months (HR 0.64) • Delivered an 8.6-month absolute PFS gain after

One interesting finding from VIKTORIA-1 was that the fulvestrant gedatolisib doublet performed nearly as well as the triplet, despite this being an exploratory analysis. • Gedatolisib + fulvestrant achieved a median PFS of 11.3 months vs 5.6 months with alpelisib + fulvestrant

ASCENT-03: Even with 82% crossover to SG in the chemo arm, 1L SG maintained a PFS2 benefit. PFS2: 18.2 vs 14.0 months (HR 0.70) An important reminder that when effective therapies exist, PFS2 can provide valuable insight into the impact of treatment sequencing. Kudos to https://t.co/pSZ30HpJXb

lidERA subgroup analysis by menopausal age: Both pre and postmenopausal patients benefited with Giredestrant. https://t.co/OGv8JgIzUG