News & Comment

Despite recent advances in breast cancer research, we still know little about the mechanisms that lead to metastatic breast cancer (MBC). However, treatment options for patients have increased based on results of recent randomized clinical trials in this setting. Today we have much hope, yet many questions remain unanswered. Conducting a fully academic and international study such as AURORA is very challenging, yet ever more crucial to advancing knowledge about MBC.

The combination of an endocrine agent with a CDK4/6 inhibitor is the standard of care in the first-line setting for patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Randomized trials have demonstrated similar and significant improvements in progression-free survival using the three available CDK4/6 inhibitors and led to regulatory approval. However, mature overall survival data now suggest potential differences among the various agents, suggesting an evolution in selection preferences.

Artificial intelligence methods are been increasingly used for analysis of pathology slides. In this issue of the Journal, Sandbank et al. describe the validation and utility of a robust second reader system that can distinguish in situ and standfirst invasive carcinomas from non-neoplastic lesions of the breast.

Multigenic tests represent an essential tool for the selection of adjuvant therapy in estrogen-positive/HER2-negative (ER + /HER2-) early breast cancer (BC). The workflow of these tests, either if they are externalized or carried out in-house, generates a workload for the pathology laboratories, that is often underestimated and may affect timely therapy initiation. Here, we describe the evolving role of pathology laboratories in using multigenic tests and, more in general, in providing adequate tissue for molecular analyses. Moreover, we propose a “reflex testing” model, in which pathologists, based on pre-specified and shared criteria, are expected to action multigene testing independently of multidisciplinary team discussion in ER + /HER2- BC patients, in order to optimize turnaround time and proper therapy intervention.