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Breast cancer care is shifting rapidly, with new drug approvals reshaping treatment across multiple subtypes. A 2024 expert consensus review now has several updates, including a second oral SERD, a new frontline immunotherapy combo for triple-negative disease, and a third approved antibody-drug conjugate. But key questions — especially around sequencing ADCs — remain unanswered.
Breast cancer treatment is one of oncology's fastest-moving fields, and a 2024 expert consensus review — built on a modified Delphi process to address gaps where level 1 evidence is lacking — is already partly outdated. Across four key areas (ER targeting, immunotherapy in triple-negative breast cancer, antibody-drug conjugates, and HER2+ early-stage disease), three have seen major shifts since the review was published.
On the endocrine therapy front, the oral SERD landscape expanded with FDA approval of imlunestrant in September 2025 and vepdegestrant (a novel ER-degrading PROTAC) in 2026, joining elacestrant as options for ESR1-mutated disease. In triple-negative breast cancer (TNBC), sacituzumab govitecan plus pembrolizumab was FDA-approved in June 2026 as a frontline option for PD-L1–positive disease, after showing superior progression-free survival over chemo plus pembrolizumab. Datopotamab deruxtecan also earned approvals in both HR+/HER2-negative and first-line TNBC settings.
Key Takeaways:
Why it matters: With approvals outpacing guideline updates, oncologists are navigating increasingly complex treatment decisions — particularly around ADC sequencing — without validated roadmaps. The next BTG Breast Cancer meeting in November 2026 aims to tackle these unresolved questions head-on.
