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ASCO 2023 | Breast cancer at ASCO 2023: NATALEE and sequencing ADCs

Paolo Tarantino, MD, Dana-Farber Cancer Institute, Boston, MA, provides an overview of key updates in breast cancer from the American Society of Clinical Oncology (ASCO) 2023 Annual Congress, including the NATALEE Phase II trial (NCT03701334) which met its primary endpoint with a clinical meaningful benefit observed with ribociclib plus endocrine therapy in patients with early breast cancer. In addition, Dr Tarantino also discusses the findings of a retrospective analysis evaluating the sequencing of antibody-drug conjugates approved in the breast cancer space. This interview took place at the American Society of Clinical Oncology (ASCO) 2023 Annual Congress in Chicago, IL.

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Transcript (edited for clarity)

So there has been a lot of interesting data presented and a lot will be presented today as well. I have to say, I think the highlight of the congress was the NATALEE Phase III trial. This was a trial of adjuvant ribociclib for three years for patients with hormone receptor positive, high risk early stage breast cancer. And interestingly we have already an adjuvant CDK approved that is abemaciclib based on the monarchE data...

So there has been a lot of interesting data presented and a lot will be presented today as well. I have to say, I think the highlight of the congress was the NATALEE Phase III trial. This was a trial of adjuvant ribociclib for three years for patients with hormone receptor positive, high risk early stage breast cancer. And interestingly we have already an adjuvant CDK approved that is abemaciclib based on the monarchE data. But this is only for patients with no positive disease, whereas in NATALEE there were also patients with high risk, not negative disease included, which is a very large population. And it was important to see in this trial the IDFS curves diverge. And so there seemed to be a benefit at two and three years with the use of ribociclib versus placebo, and there was a 25% reduction in the risk of recurrence. It is still an early time point because more than 80% of the patients are still receiving ribociclib in the study. They still haven’t discontinued, haven’t completed the three years. And so I think we have to wait some more time in order to fully understand what will happen to these patients. But I think it’s very encouraging at this point to see this benefit that we did not see with palbociclib, for instance, and knowing that ribociclib improved overall survival in the metastatic setting, we hope that the benefit in the early setting can be maintained and that in the future we might have this treatment option for our patient if the benefit is confirmed. There were other important trials, but I would like to highlight a small poster that was discussed yesterday during the poster discussion by Dr. Adelman. This was an important clinical question because nowadays we’re utilizing antibody drug conjugates in clinical practice and sometimes we use sacituzumab govitecan after T-DXd or the opposite way around. And we really have no data with these agents using sequence. And this retrospective analysis of about 30 patients that received an ADC after another ADC that was presented yesterday showed that potentially there might be decreased activity of the second ADC using sequence and suggested some potential features that we have to look at. So for instance, changing the target, changing the payload and I think it’s very early. We need more data, we need larger real world experiences. But I think it started to answer an important question for which we definitely need data in order to inform clinical practice.

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