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SABCS 2025 | Advances and challenges in MRD-guided adjuvant therapy for breast cancer

Arielle Medford, MD, Massachusetts General Cancer Center, Boston, MA, discusses the progress made since the Phase II LEADER study (NCT03285412), highlighting advancements in measurable residual disease (MRD) understanding, adjuvant CDK4/6 inhibitors, and assay sensitivity in breast cancer. However improved clinical trial infrastructure, including enhanced screening and access for patients, is still needed to fully leverage these advancements. This interview took place at the San Antonio Breast Cancer Symposium (SABCS) 2025 Meeting in San Antonio, TX.

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Transcript

I think that the LEADER study itself was a great proof of principle. I think that since then we’ve learned so much more about MRD, we’ve learned so much more about adjuvant CDK4/6 inhibitors and their efficacy, and the assays themselves have gotten even better. So now we know that if instead of designing these assays based on whole exome sequencing of the tumor’s genome sequencing, we actually have even more sensitive assays...

I think that the LEADER study itself was a great proof of principle. I think that since then we’ve learned so much more about MRD, we’ve learned so much more about adjuvant CDK4/6 inhibitors and their efficacy, and the assays themselves have gotten even better. So now we know that if instead of designing these assays based on whole exome sequencing of the tumor’s genome sequencing, we actually have even more sensitive assays. And so I think it speaks to the types of assays and measurements we should be using in this setting. And then also the clinical trial infrastructure at large. We really need to have an infrastructure where we’re having thoughtful screening, access for patients to clinical trials, not just the clinical trials existing themselves, but also means of patients getting onto these clinical trials. And I think there’s incredible promise in that space, but we need to be thinking creatively and kind of overhauling how we’re doing our clinical trial structure to get more access and more trials to patients.

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