Neil M. Iyengar, MD

A multidisciplinary panel discusses the effects of GLP-1 RA use during breast cancer care, along with insurance denials, costs, and other critical areas.

Neil Iyengar, MD, presents a second case: a 61-year-old woman with HER2-low metastatic breast cancer who progressed after 22 months on first-line palbociclib and letrozole and 8 months of subsequent endocrine therapy, now with an ESR1 and PIK3CA H1047R co-mutation.

Neil Iyengar, MD, presents a case of a 52-year-old woman with bone-only, hormone receptor-positive, HER2-negative metastatic breast cancer on first-line ribociclib and letrozole who has stable imaging at 12 months but a new ESR1 Y537S mutation on ctDNA with mild bone pain.

Carol Tweed, MD, tells community oncologists that camizestrant's cardiac and ocular effects do not require routine referral to cardiology or ophthalmology, calling asymptomatic bradycardia and photopsia a non-issue that does not impair patient function and tends to resolve over time.

Rebecca Shatsky, MD, reviews the safety profile of camizestrant based on her experience in the CAMBRIA adjuvant trials, highlighting photopsia, brief flashes of light in peripheral vision with no associated eye damage, and bradycardia, which she calls the Apple Watch effect after patients notice low heart rates on wearable devices overnight.

Rebecca Shatsky, MD, describes telling a patient with a clean scan but a new ESR1 mutation on ctDNA that treatment needs to change, saying she sets that expectation from the start of testing rather than presenting it as a surprise.

Carol Tweed, MD, unpacks how to interpret the progression-free survival benefit in the SERENA-6 trial, explaining that a second progression-free survival analysis, counted after patients on the standard arm crossed over to a subsequent therapy, still favored the camizestrant switch group.

Rebecca Shatsky, MD, walks through the design of the phase 3 SERENA-6 trial, led by Francois Bedard, who also designed the earlier PADA-1 trial using fulvestrant.

Rebecca Shatsky, MD, says her approach to co-mutations depends on the specific patient in front of her, citing a steep drop-off in response across oral selective estrogen receptor degraders that leaves a significant portion of patients without benefit.

Carol Tweed, MD, and Neil Iyengar, MD, discuss how co-occurring mutations such as PIK3CA, AKT1, and TP53 complicate treatment decisions once an ESR1 mutation emerges in hormone receptor-positive, HER2-negative metastatic breast cancer.

Rebecca Shatsky, MD, describes discussing ESR1 mutation results with patients, walking them through ctDNA clonal expansion data on a Guardant360 report and explaining why treatment needs to change before disease progresses.

Although shortages periodically capture national attention when widely used agents such as cisplatin or carboplatin become scarce, the problem extends well beyond any single drug.

ASCO 2026 spotlights metabolic health in cancer care, as GLP-1 obesity drugs show links to lower metastasis and survival gains, needing trials.

The faculty open the episode by discussing how most patients with hormone receptor-positive, HER2-negative metastatic breast cancer begin treatment with a CDK4/6 inhibitor plus an aromatase inhibitor and many respond well, sometimes for years.

The panel discusses a 52-year-old patient with metastatic TNBC including lung lesions and previously treated stable brain metastases, presenting for first-line treatment recommendations.

The panel reviews a 58-year-old patient with HR-positive, HER2-negative metastatic breast cancer progressing after endocrine therapy plus CDK4/6 inhibitor treatment. The patient has hepatic and bone metastases with radiographic and symptomatic progression, ECOG performance status 1, controlled hypertension, and mild dry eye syndrome. She prioritizes maintaining professional activity and independence.

Dr. Iyengar addresses common patient fears about vision loss, noting this represents a primary concern when discussing ocular toxicity. Dr. Sunshine provides reassurance that these represent reversible changes with appropriate monitoring and early intervention, emphasizing the importance of early detection through regular examinations.

Dr. Sunshine provides ophthalmologic perspective on Dato-DXd's unique ocular surface events, representing a new toxicity profile for breast oncology practitioners. The management approach begins with baseline patient education and ophthalmologic examination, establishing foundation for both patient awareness and professional monitoring.

Dr. Nunnery describes TROPION-Breast02 studying Dato-DXd in frontline patients with metastatic TNBC for patients ineligible for immunotherapy, similar to ASCENT-03 design but with important differences in eligibility criteria.

Dr. Nunnery discusses ASCENT-07, which moved SG earlier in the treatment sequence for HR-positive disease, allowing patients progressing on endocrine therapy to receive the ADC immediately rather than requiring intervening chemotherapy. Surprisingly, this frontline comparison against standard chemotherapy yielded negative results without statistically significant PFS improvement.

New ADC trial data reshapes metastatic breast cancer care: why OS differs, where T-DXd fits, and SG’s frontline gains in TNBC.

Experts unpack new antibody-drug conjugate trial data, sequencing choices, and toxicity management reshaping metastatic breast cancer care.

Explore how ADCs, ctDNA monitoring, and new endocrine options reshape metastatic breast cancer care, as well as sequencing and toxicity tips from experts.

As the journal ONCOLOGY reaches it's 40-year anniversary, it's important to reflect on the transformation of cancer care in that time, according to Julie M. Vose, MD, MBA, and Neil M. Iyengar, MD.

Read about recent advancements in breast cancer treatment, including new therapies and survival data, showcased at the upcoming ESMO 2025 Congress.

Patients with breast cancer experience significant weight loss after using GLP-1 receptor agonists, highlighting potential benefits for obesity management in this population.

Exercise significantly enhances cancer treatment outcomes, improving survival rates and quality of life for patients with colon cancer who have completed therapy.

Neil M. Iyengar, MD, highlighted the recent T-DXd and Dato-DXd approvals in breast cancer.