Oncology Masterclass / Symposium Video overview 

ER+/HER2- metastatic breast cancer: Highlights from the APBCS 2026 Satellite Symposium

Experts discuss 2L+ treatment strategies in endocrine therapy-eligible patients

Dr Mastura Md Yusof

Dr Mastura Md Yusof
Dr Hope S. Rugo

Dr Hope S. Rugo
Prof. Matteo Lambertini

Prof. Matteo Lambertini
Publication Date

Jan 2026

info Summary and next episodes download Downloadable resources

In this conference update video, Dr Hope Rugo and Prof. Matteo Lambertini share key insights from the 14th Asia-Pacific Breast Cancer Summit (APBCS) satellite symposium, chaired by Dr Mastura, and sponsored by Menarini Stemline.

 

The faculty discuss 2nd line+ treatment strategies and sequencing following ET + CDK4/6i in endocrine therapy–eligible patients with ER+/HER2 metastatic breast cancer (mBC). 

 

Topics include: 

  • Overview of Pan-Asian and ESMO guidelines 
  • Intrinsic and acquired endocrine resistance after 1st line ET + CDK4/6i 
  • Role of biomarker-selected endocrine-based therapies and key clinical trial data 
  • Clinical relevance of ESR1 mutations and testing strategies 

 

Clinical takeaways

  • 2nd line treatment choices are defined by the eligibility to receive ET and are driven by biomarker status. For patients whose tumours retained endocrine-sensitivity, guidelines recommend exhausting sequential ET-based regimens 
  • RWE for elacestrant shows a consistent benefit, with ~8–11 months TTNT, aligning with the 8.6-month mPFS observed in patients with longer prior ET + CDK4/6i exposure in the EMERALD subgroup analysis 
  • In tumours retaining endocrine-sensitivity and coexisting PIK3CA and ESR1 mutations, elacestrant monotherapy can be a good option before PI3K/AKTi combination regimens, as data show similar efficacy with a manageable safety profile
  • ESR1-mut testing should be repeated at each progression on ET if previously negative, as detection rates increase over time. Blood-based ctDNA is the preferred method, while archival primary tumour tissue should be avoided, as ESR1-mut typically develop during metastatic treatment

Resident Consultant Oncologist for the Cancer Institute of Pantai Hospital Lumpur.

Consultant in various advisory boards and expert committee panels for cancer and cancer-related services in government such as good oncology practice and chemotherapy protocol guideline, as well as in private sectors. Worked with NGOs championing cancer awareness, early diagnosis and treatment.

Dr Mastura Md Yusof has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Zuellig, Novartis, AstraZeneca, Roche, MSD, Menarini, Juniper, Pfizer, Specialised Therapeutic

Hope S. Rugo, MD, FASCO, is a medical oncologist specializing in breast cancer research and treatment. A Professor of Medicine, Dr. Rugo joined the Breast Care Center in 1999 after a decade of experience at the University of California San Francisco (UCSF) in malignant hematology/ bone marrow transplantation. She entered the field of breast cancer in order to incorporate novel therapies with excellent quality of care into the treatment of breast cancer. Dr. Rugo graduated from the University of Pennsylvania School of Medicine in 1983. She completed a residency in internal medicine and primary care followed by a fellowship in hematology and oncology at UCSF and was a post-doctoral fellow in immunology at Stanford University. Dr. Rugo joined the
faculty at UCSF in 1990.


Dr. Rugo is the Director of Breast Oncology and Clinical Trials Education at the UCSF Helen Diller Family Comprehensive Cancer Center. She is a principal investigator of multiple clinical trials focusing on novel targeted therapeutics to improve the treatment of breast cancer, publishing widely in this area. Her research interests include immunotherapy and combinations of targeted agents to treat breast cancer, as well as management of toxicity. She is co-chair of the Safety Committee for the multicenter adaptively randomized phase II I-SPY2 trial, co-chair of the Triple Negative Working Group of the Translational Breast Cancer Research Consortium (TBCRC) and a member of the Alliance breast committee. Dr. Rugo is an active clinician and is committed to education. She has received a number of awards honoring her work.

Dr Hope S. Rugo has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Astellas Pharma, AstraZeneca; Daiichi Sankyo, F. Hoffmann-La Roche AG/Genentech, Gilead Sciences, GlaxoSmithKline; Lilly; Merck & Co., Novartis Pharmaceuticals Corporation, OBI Pharma, Pfizer, Pionyr Immunotherapeutics, Sermonix Pharmaceuticals, Taiho Oncology, Veru and funding for consultancy/advisory support from Puma, NAPO, Mylan, Eisai, and Daiichi
Sankyo.

Associate Professor and consultant in medical oncology at the University of Genova – IRCCS Policlinico San Martino Hospital in Genova. Member of the guideline group on fertility preservation in cancer patients for ESMO, the European Society of Human Reproduction and Embryology and the Italian Association of Medical Oncology.

Prof. Matteo Lambertini has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Roche, Lilly, Novartis, AstraZeneca, Pfizer, Gilead, MSD, Pierre Fabre, Menarini, Nordic Pharma, Bayer, Ipsen, Daiichi Sankyo, Takeda, Sandoz, Libbs, JCO Consultant Editor, Chair of the ESO Certificate of Competence in Breast Cancer.

Non-financial interests: Member of the executive board of the BIG; Board member of the ISFP; ASCO Annual Meeting Scientific Program Committee on the Breast Cancer – Local/Regional/ Adjuvant Track
pdf Download Slides - PDF clock

In this conference update video, Dr Hope Rugo and Prof. Matteo Lambertini share key insights from the 14th Asia-Pacific Breast Cancer Summit (APBCS) satellite symposium, chaired by Dr Mastura, and sponsored by Menarini Stemline.

 

The faculty discuss 2nd line+ treatment strategies and sequencing following ET + CDK4/6i in endocrine therapy–eligible patients with ER+/HER2 metastatic breast cancer (mBC). 

 

Topics include: 

  • Overview of Pan-Asian and ESMO guidelines 
  • Intrinsic and acquired endocrine resistance after 1st line ET + CDK4/6i 
  • Role of biomarker-selected endocrine-based therapies and key clinical trial data 
  • Clinical relevance of ESR1 mutations and testing strategies 

 

Clinical takeaways

  • 2nd line treatment choices are defined by the eligibility to receive ET and are driven by biomarker status. For patients whose tumours retained endocrine-sensitivity, guidelines recommend exhausting sequential ET-based regimens 
  • RWE for elacestrant shows a consistent benefit, with ~8–11 months TTNT, aligning with the 8.6-month mPFS observed in patients with longer prior ET + CDK4/6i exposure in the EMERALD subgroup analysis 
  • In tumours retaining endocrine-sensitivity and coexisting PIK3CA and ESR1 mutations, elacestrant monotherapy can be a good option before PI3K/AKTi combination regimens, as data show similar efficacy with a manageable safety profile
  • ESR1-mut testing should be repeated at each progression on ET if previously negative, as detection rates increase over time. Blood-based ctDNA is the preferred method, while archival primary tumour tissue should be avoided, as ESR1-mut typically develop during metastatic treatment 

Resident Consultant Oncologist for the Cancer Institute of Pantai Hospital Lumpur.

Consultant in various advisory boards and expert committee panels for cancer and cancer-related services in government such as good oncology practice and chemotherapy protocol guideline, as well as in private sectors. Worked with NGOs championing cancer awareness, early diagnosis and treatment.

Dr Mastura Md Yusof has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Zuellig, Novartis, AstraZeneca, Roche, MSD, Menarini, Juniper, Pfizer, Specialised Therapeutic

Hope S. Rugo, MD, FASCO, is a medical oncologist specializing in breast cancer research and treatment. A Professor of Medicine, Dr. Rugo joined the Breast Care Center in 1999 after a decade of experience at the University of California San Francisco (UCSF) in malignant hematology/ bone marrow transplantation. She entered the field of breast cancer in order to incorporate novel therapies with excellent quality of care into the treatment of breast cancer. Dr. Rugo graduated from the University of Pennsylvania School of Medicine in 1983. She completed a residency in internal medicine and primary care followed by a fellowship in hematology and oncology at UCSF and was a post-doctoral fellow in immunology at Stanford University. Dr. Rugo joined the
faculty at UCSF in 1990.


Dr. Rugo is the Director of Breast Oncology and Clinical Trials Education at the UCSF Helen Diller Family Comprehensive Cancer Center. She is a principal investigator of multiple clinical trials focusing on novel targeted therapeutics to improve the treatment of breast cancer, publishing widely in this area. Her research interests include immunotherapy and combinations of targeted agents to treat breast cancer, as well as management of toxicity. She is co-chair of the Safety Committee for the multicenter adaptively randomized phase II I-SPY2 trial, co-chair of the Triple Negative Working Group of the Translational Breast Cancer Research Consortium (TBCRC) and a member of the Alliance breast committee. Dr. Rugo is an active clinician and is committed to education. She has received a number of awards honoring her work.

Dr Hope S. Rugo has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Astellas Pharma, AstraZeneca; Daiichi Sankyo, F. Hoffmann-La Roche AG/Genentech, Gilead Sciences, GlaxoSmithKline; Lilly; Merck & Co., Novartis Pharmaceuticals Corporation, OBI Pharma, Pfizer, Pionyr Immunotherapeutics, Sermonix Pharmaceuticals, Taiho Oncology, Veru and funding for consultancy/advisory support from Puma, NAPO, Mylan, Eisai, and Daiichi
Sankyo.

Associate Professor and consultant in medical oncology at the University of Genova – IRCCS Policlinico San Martino Hospital in Genova. Member of the guideline group on fertility preservation in cancer patients for ESMO, the European Society of Human Reproduction and Embryology and the Italian Association of Medical Oncology.

Prof. Matteo Lambertini has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Roche, Lilly, Novartis, AstraZeneca, Pfizer, Gilead, MSD, Pierre Fabre, Menarini, Nordic Pharma, Bayer, Ipsen, Daiichi Sankyo, Takeda, Sandoz, Libbs, JCO Consultant Editor, Chair of the ESO Certificate of Competence in Breast Cancer.

Non-financial interests: Member of the executive board of the BIG; Board member of the ISFP; ASCO Annual Meeting Scientific Program Committee on the Breast Cancer – Local/Regional/ Adjuvant Track
pdf Download Slides - PDF clock
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