The edition · Oncology
After a CDK4/6 inhibitor, an oral SERD with everolimus nearly doubled progression-free survival in ESR1-mutated breast cancer
evERA adds a partner for everolimus, tomosynthesis screening and interval cancers, radiation to oligometastases on EGFR inhibitors, and the safety of radiosurgery with checkpoint inhibitors.
The edition in brief
evERA randomised 373 patients with ER-positive, HER2-negative advanced breast cancer progressing after a CDK4/6 inhibitor to the oral SERD giredestrant or standard endocrine therapy, both with everolimus. In ESR1-mutated tumours median progression-free survival was 10.0 versus 5.5 months (HR 0.38); in all patients 8.8 versus 5.5 months (HR 0.56), with similar toxicity. TOSYMA found 24% fewer invasive interval cancers over two years after tomosynthesis plus synthesised mammography than after digital mammography (14.2 vs 18.6 per 10,000; OR 0.76, 95% CI 0.55–1.06), not statistically significant, though the 12-month difference was. A meta-analysis of nine mostly observational studies (1,077 patients) associated local ablative therapy added to first-line EGFR TKI in oligometastatic NSCLC with longer overall survival (HR 0.50) and PFS (HR 0.44), without more toxicity. A single-arm meta-analysis of 2,587 patients receiving stereotactic radiosurgery with PD-1/PD-L1 inhibitors for brain metastases found one-year local control of 87% and grade 3 radionecrosis in 5%.
Tomosynthesis screening: fewer interval cancers, but not a significant difference at two years
Tomosynthesis was associated with about a quarter fewer interval cancers, but the two-year result was not statistically significant.
Adding local ablative therapy to EGFR inhibitors linked to longer survival in oligometastatic NSCLC
Consider consolidative local therapy for selected oligometastatic EGFR-mutated NSCLC on a TKI, after multidisciplinary review.
Radiosurgery with checkpoint inhibitors for brain metastases: 87% local control, 5% grade 3 necrosis
Radiosurgery during checkpoint inhibition gave high local control; quote about a 5% grade 3 radionecrosis risk.
Retest for ESR1 mutation at each progression on endocrine therapy
Retest ESR1 on circulating tumour DNA at every progression on endocrine therapy.
evERA: giredestrant plus everolimus beat standard endocrine therapy plus everolimus
In ESR1-mutated breast cancer after a CDK4/6 inhibitor, an oral SERD with everolimus nearly doubled progression-free survival.
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