Results from studies presented at the ESMO Congress 2023 (Madrid, 20–24 October) outline different strategies involving indirect immune modulation and direct enhanced tumour cytotoxicity to improve on chemotherapy as the current standard of second-line care after ICI progression

The SAPPHIRE trial failed to meet its primary endpoint compared with chemotherapy

In the KEYNOTE-A18 study, the combination of pembrolizumab and concurrent chemoradiotherapy significantly improved progression-free survival

Promising data from the ATTLAS phase III study indicate a potential new approach for treating patients progressing on TKIs 

Adding immunotherapy to standard of care shows benefit compared with placebo and is confirmed to be practice-changing for this patient population

The impact of immunotherapy on disease progression and survival remains uncertain, but biomarker selection may be the future

Efficacy of PD-1 inhibitors in this setting reflects that reported in triple-negative breast cancer and is confirmed by long-term data presented at the ESMO Congress  

Regulatory, practical and economic challenges are associated with implementing this personalised treatment on a larger scale, thus currently limiting its availability and accessibility to patients

Data presentations from DESTINY-Breast04, DESTINY-Breast02 and EMERALD trials confirm the value of trastuzumab deruxtecan and elacestrant in this setting, despite moderate drop-out rates for PROs  

Extended analyses from two regulatory phase III trials show that the benefits of anti-PD-1-based therapy persist long term, even in patients with brain metastases