Yasuaki Sagara MD, MPH

Clinical high risk does not always mean genomic high risk. In the OPTIMA trial, many ER+/HER2− early breast cancer patients with node-positive disease — including premenopausal women — maintained excellent outcomes without routine chemotherapy when Prosigna/PAM50 ROR scores were low. A major step toward biology-guided chemotherapy de-escalation. Study: Stein et al, #ASCO2026 #BreastCancer #Oncology #MedEd #MVOnco

ASCO 2026 Update — lidERA Trial Menopausal Subgroup Analysis • Giredestrant improved IDFS and DRFI across both menopausal groups • Strongest signal seen in PRE-menopausal patients • ~42% relative reduction in recurrence risk in PRE-menopausal subgroup • Particularly notable DRFI improvement in younger higher-risk patients • All PRE-menopausal patients received ovarian suppression • Fewer discontinuations vs standard endocrine therapy Questions remain: • OS immature • Longer follow-up awaited • Full publication pending The adjuvant oral SERD era continues to evolve. #ASCO2026 #BreastCancer #Oncology #MVOnco

#ASCO26 DESTINY-Breast05 ILD analysis ILD was more frequent with T-DXd. Interesting signal: ILD was more common in Japan. Genetic susceptibility, imaging/diagnostic threshold, reporting practice, and RT techniques may all contribute. RT timing does not seem to make a major difference: T-DXd ILD Sequential RT: 10.7% Concurrent RT: 9.6% @SuyogCancer , this may be the answer to the question you raised in the wp group🙂 Of course, the radiotherapy device/technique used probably matters as well.

#ASCO26 KN-522 final analysis. Median follow-up: 7.8 years. 7-year EFS: 78.3% vs 69.8% HR 0.68 7-year OS: 85.1% vs 77.2% HR 0.64

いやこれ怖いな、AIの特性はよく知っておく必要がある ”スタンフォード大のマイラ・チェンらの研究は、AIに人間関係の相談をすることの潜む危険性を警鐘している。 実社会の事例を用いた実験では、ChatGPTなど11の主要AIモデルすべてが、人間の約1.5倍もユーザーに同調することが判明した。嘘や詐欺、違法行為といった不適切な行動に対しても、約半数のケースでAIが容認・肯定する姿勢を示したという。 さらに、実際の人間関係の悩みをAIに相談させる実験では、同調的なAIと会話した人ほど「自分が正しい」と思い込み、謝罪や責任転嫁の拒否、関係修復への意欲低下が見られた。それにもかかわらず、利用者はその心地よさから、再びAIに頼りたくなる依存傾向に陥っていた。 研究チームは、AIが利用者の機嫌を取る「追従性（お世辞）」は、対人関係の摩擦耐性を弱らせる安全上の脅威であると指摘する。AIは客観的な助言ではなく、利用者が「聞きたい言葉」を返しているに過ぎず、人間関係を密かに悪化させている。そのため、人間関係のナビゲートをAIに代行させるべきではないと結論付けている。”

The most important breast abstract from #ASCO26 is out. 4429 pts with ER+/HER2- BC randomized to SoC vs PAM50-directed adjuvant treatment. 19% had N2 dz (4-9 nodes), premenopausal pts received LHRHa. No benefit from chemo if ROR≤60. Looking forward to the full presentation.

【新着Note】諸外国の乳がん診療集約化に学ぶ ドイツWiZen研究（Schmitt et al. Dtsch Arztebl Int 2023） 対象患者数≒2,200万 ✅認定施設での治療で死亡リスク23%減（HR=0.77） ✅全がん種で生存率改善、乳癌で最大 英・独・蘭・米・韓6カ国の認定施設のモデルを比較し、日本への示唆も整理しました。 #乳がん #医療政策 #集約化 note.com/bpm54321/n/na1…

ASCO 2026 is coming soon. Here’s a simplified look at 8 selected oncology studies that may shape upcoming discussions across solid tumors and hematologic malignancies. Quick, mobile-friendly, and focused on: • the trial • the setting • the key signal • why it may matter in practice Full data and longer follow-up awaited for many studies. #ASCO2026 #Oncology #MedTwitter #HemOnc #MVOnco

❓Are we approaching a future where some HER2+ breast cancer brain metastases may be managed WITHOUT upfront WBRT? 🧠 CNS metastases have long been the Achilles’ heel of HER2+ breast cancer. But this comprehensive new review highlights how modern HER2-targeted therapies are rapidly reshaping outcomes, even in active brain metastases and leptomeningeal disease. 🚀 Key takeaways 👇 🔹 T-DXd demonstrated remarkable intracranial activity • IC-ORR ~60-70% across studies • DESTINY-Breast12 showed durable CNS control even in active BMs • Potential paradigm shift toward delaying or avoiding upfront WBRT in selected patients 🔹 Tucatinib-based therapy remains a CNS cornerstone HER2CLIMB confirmed: • 40% reduction in risk of death • 66% reduction in CNS progression • Strong activity in both active and stable brain metastases 🔹 Treatment philosophy is evolving The proposed algorithm increasingly integrates: 🧬 CNS-active systemic therapy 🎯 SRS/SRT 🧠 Selective surgery ⚠️ Reduced reliance on WBRT due to neurocognitive toxicity 🔹 Leptomeningeal disease (LMD) Historically devastating, but newer data with: • T-DXd • Tucatinib-based combinations • Intrathecal trastuzumab are finally showing clinically meaningful survival signals. 🔹 Emerging concept: In selected asymptomatic patients with active CNS disease, highly CNS-active systemic therapy may potentially delay or replace immediate local therapy. A major shift from “brain as sanctuary site” → “brain as treatable disease compartment.” 📖 Comprehensive review + therapeutic algorithm proposal in Cancer Treatment Reviews. #bcsm #BreastCancer #HER2 #NeuroOncology #OncoTwitter #MedTwitter @myesmo @asco @ESMO_Open @OncoAlert

🌸 THE 10 MOST IMPORTANT BREAST CANCER TRIALS OF #ASCO26 Chicago is loaded this year. From ctDNA-guided endocrine switching to frontline ADCs and next-gen HER2 platforms, these are the studies most likely to shape breast oncology practice 👇 🩷 HR+ / HER2- DISEASE 1️⃣ persevERA BC (LBA1006) Giredestrant + palbociclib vs letrozole + palbociclib in 1L metastatic disease Despite missing the primary PFS endpoint, biomarker/subset analyses may define where oral SERDs still fit. 2️⃣ SERENA-6 (LBA1007) Camizestrant for emergent ESR1 mutations detected via ctDNA BEFORE radiographic progression Possibly the biggest ctDNA-guided endocrine strategy discussion of the meeting. 3️⃣ VIKTORIA-1 Gedatolisib + fulvestrant ± palbociclib after AI + CDK4/6i progression Huge unmet-need population. Post-CDK4/6 sequencing remains one of the biggest HR+ questions. 4️⃣ lidERA BC (Abstract 502) Adjuvant giredestrant in early ER+/HER2- disease Moving oral SERDs into curative-intent therapy. 5️⃣ FOURLIGHT-2 (Abstract 1042) Next-gen CDK4-selective inhibition with atirmociclib + letrozole Can we reduce neutropenia while preserving efficacy? 🔥 TNBC & ADC ERA 6️⃣ ASCENT-04 (LBA1000) Sacituzumab govitecan + pembrolizumab vs chemo + pembrolizumab in PD-L1+ mTNBC Could ADC + IO combinations become the frontline standard? 7️⃣ TROPION-Breast02 Dato-DXd vs chemotherapy in metastatic TNBC A major test of the “ADC-first” paradigm. 🎯 HER2+ & NEXT-GEN NEOADJUVANT PLATFORMS 8️⃣ KN026-004 (LBA660) Novel biparatopic HER2 antibody vs classic CLEOPATRA-style therapy Watch the pCR data carefully. 9️⃣ I-SPY 2.2 (LBA514) Rilvegostomig + T-DXd in high-risk HER2-negative disease IO + ADC combinations continue moving earlier. 🔟 DESTINY-Breast05 Update Long-term outcomes for T-DXd vs T-DM1 in residual HER2+ disease Which breast abstract are you watching most closely? #BCSM #OncoTwitter #ASCO26 #BreastCancer #MedEd @asco @myesmo @esmo_open @OncoAlert @OncBrothers

🚨 THE 15 MOST IMPORTANT TRIALS OF #ASCO26 May 29 - June 2 | Chicago Which trial are you watching most closely? 🌟 PLENARY GAME-CHANGERS 1️⃣ PROTEUS Perioperative apalutamide + ADT in high-risk localized prostate cancer 2️⃣ LIBRETTO-432 Adjuvant selpercatinib in RET+ NSCLC 3️⃣ HARMONi-6 Ivonescimab + chemo vs tislelizumab + chemo in squamous NSCLC 4️⃣ RASolute 302 Daraxonrasib (RMC-6236) in metastatic pancreatic cancer 5️⃣ SARC041 Abemaciclib in dedifferentiated liposarcoma ⚡ FRONTLINE & PERIOPERATIVE SHIFTS 6️⃣ KEYNOTE-B15 / EV-304 EV + pembrolizumab vs chemo in MIBC 7️⃣ LITESPARK-022 Pembrolizumab + belzutifan in adjuvant ccRCC 8️⃣ AMBITION Paclitaxel/bevacizumab ± atezolizumab in HR+ breast cancer 9️⃣ NeoADAURA Neoadjuvant osimertinib in EGFR+ NSCLC 🔟 A-DREAM ADT interruption strategies in mCSPC 🧬 PRECISION, ADCs & NEXT-GEN IMMUNOLOGY 1️⃣1️⃣ DESTINY-Breast06 T-DXd expands into HER2-ultralow disease 1️⃣2️⃣ CROWN (7-year update) Lorlatinib durability in ALK+ NSCLC 1️⃣3️⃣ DeLLphi-312 Tarlatamab in frontline SCLC 1️⃣4️⃣ COMMIT Atezolizumab + FOLFOX/Bev in MSI-H mCRC 1️⃣5️⃣ IMvigor011 ctDNA-guided adjuvant atezolizumab in bladder cancer #OncoTwitter #MedTwitter #ASCO26 #CancerResearch @OncoAlert @ASCO @JCOPO_ASCO @OncBrothers

Today we all lost our jobs..... Three Nature papers showing that scientists in the conventional sense are obsolete At least read the first one.... the AI replaced all things that the scientist does .... nature.com/articles/s4158…

一昨日の中医協で、サスメドの不眠障害治療支援アプリ「Medcle」がついに保険適用されました！ アジヘルブログで最速（僕調べ）の解説記事を書きましたので、DTxやSaMDに取り組まれている方はぜひお読みください！ healthcareit.jp/?p=7800&utm_so… #サスメド #SaMD #DTx

【FAST-Forward試験 10年成績｜Lancet Oncology 2026】 早期乳癌の術後照射において、1週5回照射(26Gy/5fx)が標準的3週15回照射(40Gy/15fx)に対し10年時点でも非劣性を維持することを示した、英国97施設・4087例の多施設非盲検phase 3 RCT。 ▼主要結果(ITT, 中央追跡10.1年) ・同側乳房再発10年累積発生率 　40Gy群 3.6% (95%CI 2.7-4.9) 　27Gy群 2.9% (2.1-4.0), HR 0.90 (0.59-1.37) 　26Gy群 2.1% (1.5-3.1), HR 0.66 (0.41-1.04) ・領域再発、遠隔再発、全生存にも群間差なし ・10年全生存 約85%(全群同等) ▼晩期有害事象(医師評価, 中等度以上) ・乳房/胸壁いずれかの有害事象 10年時点 　40Gy 13.1%、27Gy 19.3%、26Gy 14.4% ・26Gy群は40Gy群と同等、27Gy群のみ収縮・硬結・浮腫が増加 ・症候性肋骨骨折・肺線維化・虚血性心疾患は全群で稀 ・α/β=2.1Gy(線量効果), EQD2は26Gyで46.3Gy、40Gyで46.5Gy ▼腋窩照射サブスタディ(5年データ, 466例, メタ解析統合) ・26Gy群の同側乳房再発5年累積1.2%、領域再発4.2% ・40Gy群と同等で、26Gyを腋窩照射に拡張可能と示唆 ・ただし症例数限られ精度に制約あり ▼診療上のポイント 26Gy/5回/1週は乳房・胸壁照射の国際標準となりうる強固な10年エビデンスが揃った。腋窩照射への適応も支持されるが、サブスタディ単独ではpowerに限界があり、SDMで不確実性を共有することが推奨される。患者・医療資源・環境負荷の三方向で短縮照射の意義は大きい。27Gy/5回は晩期有害事象が増えるため非推奨。 ▼限界 COVID後の追跡完了率低下(10年データ取得率76.8%)、心血管・二次癌など稀な遅発性事象の検出力不足、内胸リンパ節照射やSIBは未検証。 doi.org/10.1016/S1470-… #乳癌 #放射線治療 #FASTForward #超寡分割照射 #腫瘍学 #LancetOncology

📌 Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 10-year efficacy and late normal tissue effects from a multicentre, open-label, non-inferiority, phase 3, randomised controlled trial and 5-year efficacy results from a randomised axillary substudy 🔗 thelancet.com/journals/lanon… @OncoAlert #OncoAlertAF

The approval of T-DXd for the (neo)adjuvant treatment of HER2+ breast cancer will add an invaluable tool to our arsenal. Yet, in this era of right-sizing, not all patients require T-DXd treatment to be cured. Some thoughts in my recent JCO editorial. ascopubs.org/doi/full/10.12…

ビッグニュースが舞い込んできました！ FDAでHER2陽性早期乳がんに対するエンハーツ(トラスツズマブ　デルクステカン)が承認されました。 しかも、DB-11試験に基づく術前ハイリスク集団と、DB-05試験に基づく術後残存病変を有する集団の、両方に対して一気に適応されます。 同じように、日本での承認が待たれます。果たして術前も同時に承認されるのかがポイントになります。 fda.gov/drugs/resource…

@KolPulseAI @DrRishabhOnco @kazuki_nozawa @to_be_elizabeth I suppose I may not influence wording but I don’t think this an OS miss when there was only 53% power to detect a big difference. That is actually the issue. And 30% had no prior CDKi. Major imbalance in post PD Rx. In the 70% with prior CDK OS better. @OncoAlert @OncBrothers

npj Breast Cancerに最新論文が掲載されました。 HER2陽性乳がんにおいて、術前療法でpCRを達成しても遠隔転移リスクは残ります。本研究では、pCR症例の5年脳転移率が2.6%であること 「pCR＝完治」ではない現状に対し、特に脳への注意が必要であることを示唆しています。 nature.com/articles/s4152…