I did see a poster at #ASCO21 about KRAS mutations being associated with shorter PFS - will see if my question about this is answered. #bcsm

Missed posting about #ASCO21 today - my baby is getting ready to move to NYC and I was busy helping her pack/load car. #FamilyFirst

Still need to cover some interesting sessions/posters on CDK4/6 resistance, but have to go to the grocery store and take the dog for a walk - Gryffindor is giving me the sad eyes! See you later. #ASCO21 #bcsm

and another plain language summary (I may just swoon with joy) #ASCO21 #bcsm #PlainLanguage

Can we stay #NotDeadYet for a meaningful amount of time on alpelisib? Abstract 1054 looks at data from SOLAR1 and X2101 trials and concludes yes - about 30% of people in SOLAR1 and 13% in X2101 had a PFS > 18 months. All had endocrine resistant disease. #ASCO21 #bcsm

And a huge THANK YOU for this plain language summary/infographic, accessed via the QR code on the poster!! #ASCO21 #bcsm

about 40% of us with ER+ MBC will have/develop a PIK3CA mutation. Many of us will have been on a CDK4/6 inhibitor prior. Does the length of time on a CDK4/6i influence our response to alpelisib? Abstract 1060, subgroup analysis of BYlieve, suggests no. #ASCO21 #bcsm

Let's end with a look at PIK3CA. Gotta love real world evidence and I definitely love Dr @hoperugo who's helping me stay #NotDeadYet. Abstract 1068. Use of alpelisib based on the mutations that were described in SOLAR1, but other PIK3CA mutations may benefit as well #ASCO21 #bcsm

ClinicalTrials.gov

clinicaltrials.gov/ct2/show/NCT04448886 #ASCO21 #bcsm

We're still on ER+ #metastaticbreastcancer. Why? Because it's the subtype I have and, therefore, the one I pay the most attention to (I'm not getting paid for this; if I were I'd give all subtypes equal time! #ASCO21 #bcsm

ClinicalTrials.gov

clinicaltrials.gov/ct2/results

#ASCO21 #bcsm #SERD

Abstract 1050 is yet another oral SERD, LY3484356 (poor nameless thing). Phase 1 trial (EMBER), 3 prior LOT allowed. Dr @ErikaHamilton9 a coauthor (does she sleep?). CBR of 78% at the 400 mg dose chosen to move forward. Main AEs nausea, fatigue, diarrhea. #ASCO21 #bcsm #SERD

Abstract 1063 discusses rintodestrant in combo with palbo. Prior CDK4/6i was not allowed and most had only 1 prior LOT. Clinical benefit rate was 60%, 56/57% with ESR1 and PIK3CA mutations. This is the only trial with this drug. #ASCO21 #bcsm

AMEERA1 is a phase 1/2 combining amcenestrant + palbo in people who had experienced progression on endocrine therapy (with or w/o prior CDK4/6i). Clinical benefit rate (complete/partial response or stability) was 90%. #ASCO21 #bcsm #SERD

While my spinal mets are behaving and I can sit at the computer, let's talk about another oral SERD, amcenestrant. SERDs are indicated for ER+ MBC, but right now there is only fulvestrant shots. There are 2 posters at #ASCO21 (1058 & TPS1104) that are based on AMEERA. #bcsm

This plain language summary/infographic on OlympiA is 😁 🥇 🎉 💥 💗. I wish every major paper/presentation that directly impacts people with #cancer (or any other disease) would do this! #ASCO21 #bcsm

RC48-ADC (sounds like something from Star Wars, maybe R2D2's cousin?) has shown efficacy in HER2low as well as HER2+ (abstract 1022 Wang et al). Trial is open in China, global trial may be on the way. #ASCO21 #bcsm

PARP inhibitors may work in germline mutations other than BRCA, ones that lead to HRD (homologous repair defects). #ASCO21 #bcsm

PARP inhibitors may work in germline mutations other than BRCA, ones that lead to HRD (homologous repair defects) like PALB2. #ASCO21 #bcsm

Nice slide from #ASCO21 plenary session talk by Dr Nadine Tung on how PARP inhibitors work. #bcsm #BRCA

The idea of HER2low may also apply to those with TNBC, again opening up new treatment options with HER2 directed ADCs (antibody to HER2 coupled with a cancer cell killing agent. Abstract e13046 Yang et al showed 38% of #metastatic TNBC was HER2low. #ASCO21 #bcsm

Abstract 1052 Bao et al showed that those with HER2low ER+ MBC had a shorter PFS on endocrine therapy + CDK 4/6 inhibitor, compared to those with HER2=0 on IHC. #ASCO21 #bcsm #HER2low

Interesting area for those of us w/ ER+HER2- #metastaticbreastcancer is the idea of HER2low (1-2+ on IHC), which could open up some exciting drugs recently approved for HER2+ disease, like trastuzumab deruxtecan (enhertu), to us. We also need predictive biomarkers. #ASCO21 #bcsm

In the phase 2, stable disease was seen in 43% of people and a partial response in 17%. Those with the Y537S ESR1 mutation had the highest clinical benefit rate, although those with D538G also showed some benefit. #ASCO21 #bcsm

In the phase 1 over half the #clinicaltrial heros had had 3+ prior LOT. The most unusual AE was a low heart rate; the others were our old "friends" nausea, diarrhea, fatigue, hot flashes. (where's the drug where the AE are glowing skin and increased energy?) #ASCO21 #bcsm

H3B-6545 is an oral medication (yay!) that inactivates ERalpha, including those receptors that have mutated to get around other endocrine therapies. Dr @ErikaHamilton9 has 2 posters on H3B-6545, describing a phase 1 and a phase 1/2 trial (abstracts 1059 and 1018) #ASCO21 #bcsm

we have SERMs (selective estrogen receptor modulators), like tamoxifen. Then there are SERDs (selective estrogen receptor degraders), like fulvestrant. Now, meet SERCAs (selective estrogen receptor covalent antagonists), like H3B-6545 (poor baby needs a name!) #ASCO21 #bcsm

one such oral SERD is giredestrant (GDC 9545). A phase 1 trial (abstract 1017) looked at it in various doses. No dose limiting toxicities were seen, and it had effect in all subgroups studied. This trial included people with locally advanced as well as MBC. #ASCO21 #bcsm

we heard updates about CDK 4/6 inhibitors with fulvestrant, a SERD (selective estrogen receptor degrader) that consists of a shot in each cheek (and not the ones you smile with!) every month. A shot in the ass is a PITA, so there is lots of interest in oral SERDs. #ASCO21 #bcsm

Took a walk with the dog, watched a movie with the daughter, watered the lawn with our trucked in water, and am now ready to get back to #ASCO21 posters on #MetastaticBreastCancer #bcsm!