{"id":544569,"date":"2026-07-11T14:19:07","date_gmt":"2026-07-11T14:19:07","guid":{"rendered":"https:\/\/www.newsbeep.com\/ie\/544569\/"},"modified":"2026-07-11T14:19:07","modified_gmt":"2026-07-11T14:19:07","slug":"what-actually-changed-for-metastatic-disease-kefah-mokbel-on-nccn-breast-cancer-v4-2026-updates","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ie\/544569\/","title":{"rendered":"What Actually Changed for Metastatic Disease? Kefah Mokbel on NCCN Breast Cancer v4.2026 Updates"},"content":{"rendered":"

Kefah Mokbel,\u00a0Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on\u00a0LinkedIn<\/a>:<\/p>\n

\u201cNCCN Breast Cancer Guidelines v4.2026: What Actually Changed for Metastatic Disease<\/p>\n

The recurrent\/stage IV section (JNCCN, July 2026) has several updates that meaningfully shift decision-making \u2013 not just recycled content.<\/p>\n

HR+\/HER2+ maintenance<\/p>\n

PATINA is now published (NEJM 2026). Adding palbociclib to maintenance endocrine + anti-HER2 therapy extends median PFS from 29 to 44 months (HR 0.75) after induction chemo. Grade \u22653 AEs 81% vs 31% \u2013 real cost, real benefit.<\/p>\n

First-line HER2+<\/p>\n

DESTINY-Breast09 shows T-DXd + pertuzumab beating THP outright (PFS 40.7 vs 26.9 months, HR 0.46). NCCN still keeps THP preferred \u2013 lack of crossover in the trial (a stated guideline limitation) plus higher ILD\/treatment-related mortality with T-DXd (12% ILD, 3.4% grade 5 vs 0.8%) likely underpin the cautious stance.<\/p>\n

TNBC first line<\/p>\n

ASCENT-04\/KEYNOTE-D19 (NEJM 2026) \u2013 sacituzumab govitecan + pembrolizumab vs chemo + pembrolizumab in PD-L1+ disease: PFS 11.2 vs 7.8 months (HR 0.65). Now category 1 preferred, first ADC-IO combo in this setting.<\/p>\n

TROPION-Breast02 matures for PD-L1 CPS <10, no germline BRCA PV: datopotamab deruxtecan beats chemo on PFS (10.8 vs 5.6 months) and OS (23.7 vs 18.7 months) \u2013 now category 1 preferred in that population, on par with sacituzumab govitecan.<\/p>\n

ESR1-mutated disease<\/p>\n

VERITAC-2 adds vepdegestrant (PROTAC ER degrader) alongside elacestrant\/imlunestrant \u2013 PFS 5.0 vs 2.1 months over fulvestrant (HR 0.58) in ESR1-mutant disease, though the trial missed its overall-population endpoint.<\/p>\n

OS data now mature for two PI3K-pathway regimens<\/p>\n

INAVO120 shows fulvestrant\/inavolisib\/palbociclib with a 7-month OS advantage (34 vs 27 months, HR 0.67). CAPItello-291\u2019s updated analysis shows an estimated 18-month OS of 74% vs 65% with capivasertib\/fulvestrant (HR 0.74) \u2013 median OS not yet reached in either arm.<\/p>\n

Watch but not yet practice-changing<\/p>\n

AMBRE\/PADMA (SABCS 2025 preliminary) suggest CDK4\/6i + endocrine can match chemo even in high-visceral-burden HR+\/HER2- disease \u2013 a direct challenge to reflexive chemo-first thinking. The guideline discusses these data in narrative text but hasn\u2019t incorporated them as a formal recommendation.<\/p>\n

The through-line: OS data finally catching up to PFS signals, and ADC-based combinations beginning to displace conventional chemotherapy backbones in selected first-line settings (notably PD-L1-positive TNBC). The THP-vs-T-DXd\/pertuzumab question is the one to watch.\u201d<\/p>\n

WHO Global Cancer Report 2026: Breast Cancer Survival Still Depends Too Much on Where a Woman Lives<\/a>
 \"What<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Kefah Mokbel,\u00a0Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University…\n","protected":false},"author":2,"featured_media":544570,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[61,60,80],"class_list":["post-544569","post","type-post","status-publish","format-standard","has-post-thumbnail","category-technology","tag-ie","tag-ireland","tag-technology"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/544569","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=544569"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/544569\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/544570"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=544569"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=544569"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=544569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}