Pick of the posters: ESMO Breast Cancer 2025
At this year’s ESMO Breast Cancer Congress 2025 (Munich, Germany; 14–17 May), we picked out some of our favorite posters from the congress and spoke to their presenters about their work, future directions and hopes for impacting clinical practice.
Contents:
- Systemic treatment after progression on first-line CDK4/6 inhibitors among patients with hormone receptor positive metastatic breast cancer: A multicenter real-world analysis
- A novel liquid biopsy workflow to identify and characterize ER and HER2-positive CTCs in metastatic breast cancer
- Key performance indicators of screening via clinical breast examination: A pooled analysis of 9.3 million screened women
- Investigation of bone mineral density, muscle strength and body composition in postmenopausal women with ER+ early breast cancer
Systemic treatment after progression on first-line CDK4/6 inhibitors among patients with hormone receptor positive metastatic breast cancer: A multicenter real-world analysis
John Padayao
Consultant, St. Luke’s Medical Center (Manila, Philippines)
Please describe your poster
In the Philippines, there is no unified algorithm when it comes to treatment after first-line CDK4/6 inhibitors. Of course, globally, the recommendation will be to perform biomarker testing or next generation sequencing, which is virtually impossible to do in the Philippines because, number one, the financial toxicity of testing, and number two, even if we test, the targeted treatments that are recommended for second-line treatment are either very expensive or not available in our clinical setting.
So, we retrospectively reviewed all of the patients who received CDK4/6 inhibitors in our institution and reviewed their second-line treatment, which is, of course, decided by their medical oncologists. We followed up and got their outcomes, particularly their progression-free survival in these second-line treatments. In the results, it was shown that around 48% of patients still received some form of endocrine treatment, which could be endocrine monotherapy in the form of fulvestrant or exemestane or re-challenging CDK4/6 inhibitors, maybe switching to another CDK4/6 or just maintaining the same CDK4/6.
It’s also very reflective of low-income countries or low-to-middle-income countries that the next line treatment is chemotherapy because, number one, it’s the most accessible and, number two, it’s also the most affordable. When we tracked the progression-free survival, it seemed that endocrine-based therapy, such as CDK4/6 inhibition, offered the longest real-world median progression-free survival, which is around 9 months, followed by endocrine monotherapy, with either fulvestrant or exemestane, which gives us 8 months. Unfortunately, chemotherapy is one of those treatments with modest progression-free survival, and in the Philippines, it’s also one of the most common treatments, so patients do not have the opportunity to maximize endocrine treatment or receive targeted treatment.
It’s also important to highlight in this study that almost 80% of patients who progress on first-line CDK4/6 do not receive or do not get any biomarker testing at all, so all those in our algorithm, such as ESR1 mutations or PIK3CA mutations, do not have the benefit of knowing that, especially in a resource-limited setting such as ours.
So, in conclusion, I think there is a very, very bright avenue for us to discuss endocrine therapy, re-challenging CDK4/6 in the second-line setting or promoting endocrine therapy and reserving chemotherapy in later lines of progression, and not as a priority for second-line treatment.
How would you like to see this research impact clinical practice?
Of course, before we lobby to government agencies that we really need biomarker testing, I think this will ground us and create a baseline data for all of our medical oncologists and convince them that there is still a statistically significant benefit for us to maximize endocrine treatment, re-challenge CDK4/6 or endocrine monotherapy, even after progression on first-line CDK4/6, and only think about giving chemotherapy to a very selected group of patients who are very sick or in visceral crisis rather than as a first option after progression.
What are your next steps for this research?
We are trying to continue this research to be a prospective cohort, trying to get more patients in and to make the data more robust and more applicable to our setting. After that, our next step is to show the non-government organizations or government organizations that, in fact, we really don’t have data on biomarkers in breast cancer and hopefully that will trigger them to somehow partially reimburse or fund some biomarker testing opportunities for our patients.
What has been your highlight of ESMO breast cancer?
I think meeting other people, meeting other young oncologists who share the same passion with breast cancer and also learning a lot from the experts whom we just read in journals and watch lectures on, so I think that’s one of the greatest things I’ve experienced so far.
A novel liquid biopsy workflow to identify and characterize ER and HER2-positive CTCs in metastatic breast cancer
Roberta Carbone
Chief Scientific Officer, Tethis S.p.A (Milan, Italy)
Please describe your poster
This study was done in collaboration with San Raffaele Hospital in Milan, with the teams led by Prof. Gentilini and Dr. Bianchini. We studied both healthy donors and patients with metastatic breast cancer. Our aim was not only to count the circulating tumor cells, but also to characterize them using specific biomarkers. In particular, we focused on estrogen receptor and HER2, since these markers are especially important in this type of breast cancer for guiding treatment decisions.
It’s an observational study designed to demonstrate the effectiveness of our technology. We use a proprietary slide called SmartBio Surface® slide, which is coated with a nanostructured titanium dioxide thin film. This coating is biocompatible and has a high affinity for living cells that don’t naturally adhere, like white blood cells. Thanks to this, we can immobilize white blood cells with about 99% efficiency, along with rare circulating tumor cells.
Once the cells are fixed on the slide, we perform in situ immunofluorescence assays using various biomarkers. This allows us not only to count the cells but, more importantly, to characterize cancer cells directly in the blood.
This approach could be important for identifying potential therapeutic options based on the expression of specific biomarkers. What we’ve done so far is a pilot clinical study involving 33 patients with metastatic breast cancer and 28 healthy donors. The next step is to expand this work into larger clinical trials with more patients to validate the method, both in breast cancer and in other cancer types as well.
What are the next steps of this research?
Building on these significant findings, our goal is to automate and standardize the entire liquid biopsy workflow, from blood collection to the generation of clinical reports, by integrating AI-driven tools for the identification and characterization of circulating cancer cells, ultimately facilitating the translation of this new cytology into clinical practice.
How would you like to see your research impact clinical practice?
Liquid biopsy has the potential to improve the quality of life for cancer patients because it allows us to monitor tumor progression in real time, and it’s non-invasive. Unlike tissue biopsies, which you can usually do only once or twice, liquid biopsies can be done repeatedly. Tissue biopsies also have limitations; they often miss tumor heterogeneity and don’t capture all the features that circulating tumor cells reveal. These cells can be found not only in blood but also in other body fluids, including those from the brain, carrying specific biomarkers and malignant characteristics.
We believe that liquid biopsy, especially through cytological characterization, represents the future of cancer diagnostics. We’re a small company, but we’re deeply committed to developing this technology to make this a useful tool, a diagnostic tool, an opportunity for patients.
What has been a highlight for you at ESMO Breast?
I like that there are so many different people and opinions here. If I could suggest something, it would be to involve more diagnostic experts alongside clinicians. That collaboration could help move precision medicine forward, since treatments that are tested on specific clinical trials should be based on the precise features of cancer patients. I’d love to see more diagnostic tools discussed together with clinical data. But overall, the conference is very interesting and inspiring for all the novel drugs that are going to be introduced to improve cancer care.
Key performance indicators of screening via clinical breast examination: A pooled analysis of 9.3 million screened women
Jack Atherton
Medical student, University of Manchester (UK).
Please describe your poster
I’m here presenting a collaborative project between the UK and Egypt which looks at clinical breast examination (CBE) as an early screening method in breast cancer. In terms of our key aims, we were looking to estimate the key performance indicators (KPIs) of CBE and compare these KPIs to other screening modalities such as mammography, combined mammography and CBE, as well as to no intervention. Encouragingly, we found that clinical CBE performed better than no intervention; however, unsurprisingly, it performed worse than mammography and even worse compared to mammography combined with CBE. However, this is still very useful and important information because it can help guide policymakers, particularly in lower resource settings where they might have financial constraints that limit their accessibility to other screening modalities, such as mammography or mammography combined with CBE, which tend to be more expensive.
In terms of our specific methods, we searched various literature databases such as Google Scholar, Scopus and PubMed, and applied our eligibility criteria – women over the age of 18, who didn’t have prior genetic predispositions or family history. We were also looking for studies that included over 10,000 women screened, and importantly, we needed to be able to extract our KPIs from only one round of screening. Finally, we needed these studies to give data that was extractable on the outcomes of CBE and, where possible, on the outcomes of a control group, such as mammography or mammography plus CBE or no intervention.
Our key endpoints were cancer detection rate, abnormal interpretation rate and the proportion of abnormal CBEs that were diagnosed as cancers. We also looked at lymph node positivity rate, early cancer rate and lymph node positivity rate.
We identified 19 studies that included over 9 million women screened from countries in North America, South America, Asia and Africa, so a very diverse clinical environment. From this, we found a pooled cancer detection rate of 1.41 per 1000 CBEs performed. Looking at the individual cancer detection rate in each study, there’s quite a large amount of variability. This is somewhat understandable, considering the wide diversity of studies we’ve included from all different parts of the world, which likely have different study populations and different study methodologies. You can see the same for a pooled proportion of abnormal CBEs diagnosed as cancers. Again, you can see a general trend and an overestimate of 31.73 cancers detected per 1000 abnormal CBEs performed. However, again, there’s quite a significant amount of heterogeneity here, which is somewhat expected.
The interesting part of the analysis for me is when we compared CBE to our other screening methods. Comparing CBE against no intervention, we got an odds ratio of 1.59, suggesting that CBE performs better than no intervention, which is very encouraging for us. When we compared mammography against CBE we got an odds ratio of 0.76, suggesting that it performs slightly worse than mammography. Then when we compared mammography and CBE, we got an odds ratio of 0.55, which suggests even worse performance. However, again, this is somewhat expected.
Overall it’s very promising.
How would you like to see this research impact clinical practice?
I hope our study results really encourage future policymakers to consider CBE, especially in low resource settings where access to expensive methodologies such as mammography and mammography combined with CBE might have some cost-benefit implications and difficulties, especially as we look towards designing improved early breast cancer detection screening campaigns.
We do have a lot of studies here where they have performed CBE, and we have shown that they are effective, especially in parts of the world where there might not currently be access to breast screening, and we have hopefully shown that they perform better than no screening at all. So, we hope that this might encourage policymakers to really consider CBE as an effective screening modality.
What are the next steps for this research?
This is all quite fresh data, so we are working on writing up the final manuscript. There were a lot of subgroup analyses, which are very interesting, that we unfortunately did not have time to talk about. For example, we found specific factors that affected our KPIs and we found that trained physicians were picking up cancers significantly better than non-trained physicians. We also found a number of interesting associations, or, study-dependent factors that predicted the efficacy of CBE.
I think our next step is just really to consolidate all of our data, write up a nice manuscript, and hopefully get it published in a high-impact global health journal that’s going to get the exposure it needs to have the impact we would hope it to have.
What has been your highlight of ESMO Breast?
It’s my first specialist cancer conference. I’ve been to some of the larger conferences in the past, such as the ESMO annual congress. I think it’s a very different perspective in a more specialized conference with all these colleagues from around the world, a lot of them who know each other and who have all these long-term relationships. And it’s also nice to delve super deep into one particular area of medicine and cancer and really see the cutting edge of this very specific area, as opposed to what can be quite overwhelming at some of the larger conferences. Also, seeing a lot of young doctors and other medical students around, I think is always great to see and a great opportunity to network with people who may end up being colleagues in the future.
Investigation of bone mineral density, muscle strength and body composition in postmenopausal women with ER+ early breast cancer
Emily Gillespie
Medical student, University of Southampton (UK)
Supervisors: Professor Ellen Copson and Professor Ramsey Cutress (University Hospital Southampton, UK)
Please describe your poster
I completed this work as part of my research project during my third year at medical school. We were looking to see if there are associations between baseline bone density, muscle strength and body composition in post-menopausal women diagnosed with ER+ breast cancer. Our research found that although bone density and muscle mass showed positive correlations, no associations were found between hand grip strength and other measures of body composition. We weren’t quite sure why this was, it could be due to differences in the side of surgery, or maybe that muscle mass is not a good proxy for muscle strength in this population. Our work also showed that at the time of the study, not all patients starting aromatase inhibitors were having DEXA scans at the time of diagnosis and therefore did not have a baseline bone density measurement.
How would you like to see this research impact clinical practice?
Hopefully, it shows the importance of scanning patients for bone health at diagnosis with ER+ breast cancer before aromatase inhibitors are commenced. Also, to add to the growing collection of clinical trials focusing on early breast cancer in postmenopausal women and encourage more work looking at baseline characteristics in this group.
What are the next steps of this research?
We’re hoping that this research could help inform the design of future interventional studies for rehabilitation programs, particularly looking to optimize patients’ bone health. It is well known that obesity and body composition are important in breast cancer, and we are keen to show that the bone density also is.
What has been your highlight of ESMO Breast?
The highlight of this conference for me was seeing everyone here and learning more about the current research in this field by looking around all the posters.