On September 19, 2020, a tweet from Dr. Matteo Lambertini (@matteolambe) woke me up and alerted me about #ESMO20. Soon, I saw my feed, filled with tweets from wonderful colleagues from around the world, including Drs. Sara Tolaney, Toni Choueiri, Andre Fabrice, and Tatiana Prowell. Excitement about #ESMO20 filled my weekend.
ESMO 2020 was unique. None of us traveled across the Atlantic or left our home. At the same time, the efficient platforms used by the ESMO team gave us a glimpse of possibilities for the future. I connected with both ESMO and the global scientific community through Twitter.
As a breast cancer doctor who is curious about major breakthroughs in all disciplines, I had no trouble accessing information through a variety of social media platforms. My colleagues and experts allowed me to pick what is important and relevant. Simultaneous publications and tweets from NEJM, Journal of Clinical Oncology, and Annals of Oncology helped me to be on top of it.
One potentially practice-changing presentation was by Dr. Stephen Johnston of Royal Marsden. Dr. Johnston presented the MONARCH-E trial (NSABP B 58), which looked at the role of abemaciclib in high-risk, ER-positive, HER2-negative, early breast cancer. The study showed an improvement in invasive disease-free survival (IDFS) in patients who received abemaciclib, which was its primary endpoint. The study included patients with four or more positive nodes, or one to three nodes and either tumor size ≥ 5 cm, histologic grade 3, or central Ki-67 ≥ 20%. All patients were ER-positive and HER2-negative. Patients received abemaciclib 150 mg PO BID for two years. At a preplanned efficacy interim analysis among 5,637 randomly assigned patients, 323 IDFS events were observed in the intent-to-treat population. Abemaciclib plus ET demonstrated superior IDFS versus ET alone (P = .01; hazard ratio, 0.75; 95% CI, 0.60 to 0.93), with 2-year IDFS rates of 92.2% versus 88.7%, respectively.
At the same time, the PALLAS trial, which randomized patients with palbociclib in adjuvant ER-positive, HER2-negative patients, failed to meet its endpoints.
CD K 4/6 inhibitors like palbociclib, ribociclib, and abemaciclib have changed the landscape of treatment of ER-positive, HER2-negative metastatic breast cancer. All these drugs have consistently doubled the progression-free survival and made an impact on overall survival. The introduction of these agents has dramatically changed the quality of life of patients with metastatic breast cancer. A majority of the patients could delay starting chemotherapy for years.
The entire breast cancer community, both patients and caregivers, were anxiously waiting for adjuvant data from ongoing CD K 4/6 agents. While palbociclib data from the PALLAS trial is disappointing, abemaciclib data from MONARCH is very promising. It is not clear why we have conflicting data from two large randomized studies. Patients in the PALLAS trial were not exactly high-risk, which were included in the MONARCH trial.
The MONARCH trial used clear clinical criteria to identify high-risk patients who will benefit from abemaciclib. I am sure ongoing and completed studies will give us a better idea about the role of adjuvant CD K 4/6 agents in the future.
Using Twitter changed my experience of the meeting. It allowed me to see the presentation by Dr. Johnson, be part of the Twitter comments by the experts, and access the article tweeted by JCO instantly. It is the future of meetings. I will continue to follow my Twitter feeds to gather more information and connect with experts around the world and the patients who follow me.
Illustration Collage : April Brust / Chief Crow Daria : shutterstock