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Top highlights from SABCS 2021

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Last updated:25th Feb 2025

Even in light of the COVID-19 pandemic, progress continues to be made in understanding the genetic heterogeneity of breast cancer and the role of metabolism in tumour progression. Importantly, we have learnt that the genetic profile of tumours is dynamic, and the need for individualised treatment regimens cannot be overemphasised.

The 44^th Annual San Antonio

Breast Cancer Symposium (SABCS) 2021

HER2+ early breast cancer and risk of recurrence

Symposium

overview

San Antonio Breast Cancer Symposium (SABCS)

SABCS 2021 overview, with top highlights and key takeaways
Specific focus on HER2+ breast cancer, including major trial updates
Advances in TKI use in HER2+ breast cancer, particularly those with clinical relevance

Professor Nadia Harbeck, MD, PhD, is the Scientific Director of the West German Study Group, Head of the Breast Center, and Chair for Conservative Oncology at the Department of OB&GYN at the University of Munich (LMU), Germany. In the following short interviews, she discusses what she considers the most interesting findings presented at SABCS 2021 and takes a closer look at HER2+ breast cancer and the use of tyrosine kinase inhibitors (TKIs).

SABCS 2021 top highlights and key takeaways

From major clinical trial updates in triple negative and luminal breast cancer to new information on circulating tumour DNA, Professor Harbeck gives a brief yet thorough overview of some of the main findings released at SABCS 2021.

Professor Nadia Harbeck has received honoraria for lectures and/or consulting from: Amgen, AstraZeneca, Daiichi-Sankyo, Exact Sciences, Gilead, Lilly, MSD, Novartis, Pierre-Fabre, Pfizer, Roche, Sandoz, Seagen. She received an honorarium from EPG Health for participating in this interview.

Day

One

Managing LMD/Targeting HER2

Managing and targeting brain metastases
Promising results for T-DXd in the CNS
Call for patients with brain metastases to be included in clinical trials
How genomics should be a part of the pathway of care using a validated framework

Treating brain metastases in HER2+ breast cancer

A high percentage of patients with HER2+ advanced breast cancer (BC) develop brain metastases (BM), and historically survival is poor. A SABCS 2021 spotlight session dedicated to managing and targeting leptomeningeal disease (LMD) in HER2+ breast cancer was kicked off by Dr Eudocia Lee from the Dana-Farber Institute, Boston.

The session began with updated results from the HER2CLIMB study^1,2 showing a median overall survival (OS) of 10 months, following extended treatment with tucatinib combined with trastuzumab and capecitabine, with a clinically meaningful benefit in central nervous system progression free survival (CNS-PFS), consistent with the primary analysis². This was the first prospective evidence of clinical benefit with a systemic regimen for HER2+ LMD.

In this study, patients with metastatic HER2-non-overexpressing BC (n=1,462) underwent genomic profiling. After 6 to 8 rounds of chemotherapy (CT), those with genomic alterations were randomised to either targeted therapies matched to genomics or maintenance CT. The median progression-free survival (PFS) improved from two months to nine months when patients received targeted therapy matched to their genomic alteration, compared to maintenance CT (hazard ratio [HR]=0.41).

However, results in the intent-to-treat population were not statistically significant (2 months to 5.5 months, HR 0.77, p=0.109). Subgroup analysis revealed that the level of ESCAT classification was highly predictive for the benefit of targeted therapy.

Extend HER protection against breast cancer recurrences

Research presented by Dr Athina Giannoudis⁵ suggests that BMs may be successfully treated with immune checkpoint and poly adenosine diphosphate-ribose polymerase (PARP) inhibitors, following analysis of their genomic landscape. Results showed that PD-L1 alterations were detected in 39% of BMs, and Programmed death-ligand 1 (PD-L1) protein expression was 27% in ER+/HER2+ and 57% ER-/HER2+ patients. These data reinforce the importance of acquiring BM material and cerebrospinal fluid for comprehensive genomic profiling.

A functional composite endpoint to characterize disease progression in patients with active or non-active secondary progressive multiple sclerosis 

First author: Ludwig Kappos

Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, Departments of Head, Spine and Neuromedicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland

Study objective: To characterise disease progression using novel composite endpoints (CEPs) relevant to SPMS and to evaluate their performance in active and non-active SPMS patients

ePoster