Post San Antonio 2024 update: chemotherapy, immunotherapy and management of side effects

Summary At the 2024 San Antonio Breast Cancer Symposium, pivotal studies addressed optimization of chemotherapy and advancements in immunotherapy in the (neo)adjuvant setting and management of side effects in breast cancer treatment. In hormone receptor-positive (HR+)/HER2-negative early breast cancer, a post hoc analysis of the TAILORx trial showed that only patients with an Oncotype DX Recurrence Score ≥ 31 benefited from anthracycline-containing adjuvant chemotherapy. In the WSG-ADAPT study, weekly nab–paclitaxel improved pathological complete response (pCR) rates compared to biweekly paclitaxel, though without a disease-free survival advantage. TRAIN‑3 supported the safety of shortening neoadjuvant chemoimmunotherapy in HER2-positive tumors following radiological complete response. In triple-negative breast cancer, both the NSABP B‑59/GeparDouze and CamRelief trials demonstrated increased pCR rates with the addition of immune checkpoint inhibitors (atezolizumab and camrelizumab, respectively), yet without significant improvement in event-free survival. Regarding supportive care, the PRO‑B study showed that digital monitoring of patient-reported outcomes (PROs) with alerts improved fatigue and survival in metastatic breast cancer. Additionally, olanzapine was more effective than prochlorperazine in managing refractory chemotherapy-induced nausea. These findings highlight the need for personalized treatment strategies and supportive care to enhance both therapeutic efficacy and quality of life in breast cancer patients.