– Atef Ashab Uddin Sahil

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This is a piece that I believe everyone who is or has ever been involved with breast cancer should read. And while every single issue addressed in this article needs individual attention, I would like to direct attention to the issue of the disparity with regard to injected versus oral medications.

Most of us are very familiar with chemotherapy that is injected. The patient travels to a treatment center and remains there for hours while the medication is injected directly into the vein. These trips are repeated for as many sessions as the oncologist recommends at designated intervals. However, with new medications that have been developed, some of the drugs are delivered in pill form only.

While the pills are not preferred for some patients depending upon their particular cancers, for those who are able to take the pills, this is a really great choice. Obviously it is so much easier to take a pill and go about your daily life uninterrupted rather than having to travel to a center for an infusion lasting a long time. And no one I know would rather have a needle to deliver their medication rather than being able to swallow a pill.

But here is the problem. Chemotherapy delivered in its usual form of infusion is covered by the guidelines of your medical plan. However, chemo in pill form is usually covered under your pharmacy plan that requires an out-of-pocket payment that may makes the drug unaffordable. If the drug is classified by the pharmacy benefit plan as “specialty tier”, that means a co-pay often ranging from 25% to 33% of the cost of the medication. As an example, if the annual cost of your medication is $60,000, your co-pay could range from $15,000 to $20,000. Most people can’t begin to afford this excessive cost.

Although 33 states and the District of Columbia have passed laws requiring insurers to provide parity for coverage of oral cancer medications that means that there are still 17 or 1/3 of the states that have no such requirements. Therefore, it is important to investigate the laws in your own State in order to find out the coverage that you have. If you find that you live in one of the States that currently has not created equality for coverage, why not start a campaign to make the change.

Perhaps you might need to enlist the help of a local organization who is willing to follow your lead and help others in this way. Or you might want to go directly to your local State representatives and plead your case. Not only will you be helping other breast cancer survivors but also you will find a focus for your own energies to make a difference.

Most likely you will find that a lack of knowledge and information is the reason that such legislation has not been enacted in your State. There is absolutely no reason why a chemotherapy drug should not be covered because of the manner in which it is administered. The ability to take a medication orally rather than having it infused not only allows for a patient to continue a more normal life but also has an added psychological benefit that can’t be measured. After all, if anyone needs as much help as possible when finding herself in the middle of a health crisis, it’s a breast cancer patient who needs chemotherapy

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– B.K. Sweeting

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From: cancerhealth.com

The Food and Drug Administration (FDA) recently approved several new therapies for breast cancer, including for patients with metastatic (Stage IV) cancer and hard-to-treat triple-negative breast cancer (TNBC). Because treatment is continually evolving, it is often possible to move on to new medications if current ones stop working.

Breast cancer, classified by the type of receptors or proteins on tumors, is not a single disease. Around 75% carry estrogen or progesterone receptors, known as HR-positive. HR-positive breast cancer is typically treated with hormone, or endocrine, therapy. Around 15% to 20% of tumors have high expression of HER2, a protein that promotes cell growth. However, a majority of tumors historically classified as HER2-negative have some HER2 expression; with more precise testing, they are now classified as HER2-low or HER2-ultralow. TNBC, accounting for about 15%, does not express any of these receptors, so it has fewer treatment options and poorer prognosis.

Datroway for TNBC

In May, the FDA approved Datroway (datopotamab deruxtecan), from AstraZeneca and Daiichi Sankyo, as a new option for previously untreated patients with inoperable or metastatic TNBC who are not candidates for PD-1 or PD-L1 checkpoint inhibitor immunotherapy. Datroway is an antibody-drug conjugate (ADC) that uses a monoclonal antibody targeting TROP-2—a protein on tumors that spurs cell growth—to deliver potent chemotherapy directly to cancer cells.

Results from the Phase III TROPION-Breast02 trial, presented at last year’s European Society for Medical Oncology Congress (ESMO 2025) and published in Annals of Oncology, showed that first-line Datroway prolonged overall survival by a median of five months compared with chemotherapy for this patient population (23.7 versus 18.7 months)—a 21% improvement—with an “unprecedented” median overall survival of approximately two years, according to a company news release. The FDA previously approved Datroway for people with inoperable or metastatic HR-positive/HER2-negative breast cancer.

“For seven out of 10 patients with metastatic triple-negative breast cancer who are not candidates for immunotherapy, chemotherapy has remained the only treatment option,” said Arlene Brothers, executive director of the Triple Negative Breast Cancer Foundation, The approval of Datroway “means that for the first time, these patients will have a new standard of care beyond traditional chemotherapy at the outset of their treatment.”

Trodelvy for TNBC

In June, the FDA gave the nod to Gilead Sciences’ TROP-2 ADC, Trodelvy (sacituzumab govitecan), as an initial treatment option for people with inoperable locally advanced or metastatic TNBC.

Based on findings from the Phase III ASCENT-03 trial, Trodelvy was approved as a solo drug for patients who are not eligible for PD-1 or PD-L1 checkpoint inhibitors. In that setting, first-line Trodelvy monotherapy reduced the risk of disease progression or death by 38% versus chemotherapy (median progression-free survival 9.7 versus 6.9 months). Further data presented at the American Society of Clinical Oncology Annual Meeting (ASCO 2026) showed that at 12 months, the second progression-free survival rates were 71% and 59%, respectively.

Trodelvy was also approved as initial treatment in combination with the checkpoint inhibitor Keytruda (pembrolizumab) for people whose tumors express PD-L1, suggesting they’re likely to respond to the immunotherapy. In the Phase III ASCENT-04/KEYNOTE-D19, Trodelvy plus Keytruda reduced the risk of disease progression or death by 35% compared with Keytruda and chemotherapy (median progression-free survival 11.2 versus 7.8 months). The second progression-free survival rates were 72% and 53%, respectively. In both trials, overall survival data are not yet mature.

Trodelvy was already approved for previously treated patients with TNBC or HR-positive/HER2-negative breast cancer. Another similar candidate, sacituzumab tirumotecan, from the Chines company Kelun-Biotech, also shows promise.

“For patients with metastatic TNBC, a new first-line treatment option offers optimism to a community with historically few choices,” Ricki Fairley, cofounder and CEO of TOUCH, the Black Breast Cancer Alliance, said in a news release. “TNBC disproportionately affects younger women—many in the prime of their lives—and often leads to poorer outcomes. Because so many patients may never receive subsequent lines of therapy, the ability to start with a promising option like Trodelvy with or without Keytruda is critical.”

Ibrance for HR-Positive/HER2-Positive Breast Cancer

During the same busy week, the FDA approved Ibrance (palbociclib) as maintenance therapy for people with locally advanced or metastatic HR-positive/HER2-positive—so-called double-positive—breast cancer. Ibrance is a CDK4/6 inhibitor that blocks proteins that promote malignant cell growth.

The new indication is for Ibrance plus hormone therapy and Herceptin, with or without Perjeta, following induction therapy. Ibrance was previously approved for patients with HR-positive/HER2-negative advanced breast cancer.

In the Phase III PATINA trial, adding Ibrance to anti-HER2 and endocrine therapy reduced the risk of disease progression or death by 24%. Study results were previously presented at the 2024 San Antonio Breast Cancer Symposium and published in The New England Journal of Medicine. Overall survival data are not yet mature.

“Resistance to dual anti-HER2 and endocrine therapy remains a central clinical challenge for patients with HR-positive/HER2-positive metastatic breast cancer—even after an excellent response to initial treatment,” lead investigator Otto Metzger, MD, of Dana-Farber Cancer Institute, said in a news release. “Based on the results from the PATINA study, the addition of IBRANCE in the maintenance phase can meaningfully extend the time patients go without their disease progressing.”

Enhertu for Earlier HER2-Positive Breast Cancer

In May, the FDA approved two new indications for AstraZeneca and Daiichi Sankyo’s Enhertu (trastuzumab deruxtecan), an ADC that uses the HER2-targeted monoclonal antibody trastuzumab to deliver chemotherapy to cancer cells. Enhertu is now approved for use before surgery (neoadjuvant therapy) and after surgery (adjuvant therapy) in patients with high-risk but potentially curable breast cancer.

The FDA initially approved Enhertu in December 2019 for patients with inoperable or metastatic HER2-positive breast cancer after hormone therapy. Approval was extended to advanced HER2-low breast cancer in August 2022 and HER2-ultralow tumors in January 2025. Now, approval has been expanded to include people with earlier-stage disease.

The Phase III DESTINY-Breast11 trial evaluated neoadjuvant Enhertu in patients with Stage II or III HER2-positive breast cancer, followed by chemotherapy, Herceptin (trastuzumab) and Perjeta (pertuzumab). As reported at ESMO 2025 and in Annals of Oncology, 67% had a pathologic complete response (no cancer found in removed tissue), compared with 56% of those who started with intensive chemotherapy.

The Phase III DESTINY-Breast05 trial tested adjuvant Enhertu for people with early HER2-positive cancer who had residual invasive disease despite neoadjuvant treatment. Enhertu reduced the risk of invasive disease recurrence or death by 53% compared to the ADC Kadcyla (trastuzumab emtansine), researchers reported at ESMO 2025 and in The New England Journal of Medicine. Both HR-positive and HR-negative patients saw a benefit.

“HER2-positive breast cancer is an aggressive disease, and our goal is to reduce the risk of recurrence for patients as early as possible to achieve the best long-term outcomes,” Shanu Modi, MD, of Memorial Sloan Kettering Cancer Center, said in a news release. “The neoadjuvant setting offers the earliest opportunity to improve outcomes, while the adjuvant setting provides another important chance to prevent recurrence for patients with residual disease after surgery.”

Revtorpyk for HR-Positive/HER2-Negative Patients

Finally, in July, the FDA approved a brand-new drug, Revtorpyk (gedatolisib), for people with HR-positive/HER2-negative locally advanced or metastatic breast cancer without a PIK3CA gene mutation. Revtorpyk, from Celcuity, is a pan-PI3K/mTOR inhibitor that interferes with a signaling pathway that promotes cancer cell growth.

The indication is for Revtorpyk plus Faslodex (fulvestrant), with or without Ibrance, for patients who have experienced disease progression during or after endocrine therapy. As described at ESMO 2025, findings from a cohort of patients with wild-type, or nonmutated, PIK3CA in the Phase III VIKTORIA-1 trial, Revtorpyk plus Faslodex and Ibrance reduced the risk of disease progression or death by 76%, and Revtorpyk plus and Faslodex lowered the risk by 67%, compared with Faslodex alone (median progression-free survival 9.3, 7.4 and 2.0 months, respectively). Study results were presented at ASCO 2026 and published in the Journal of Clinical Oncology.

The company intends to also request FDA approval of Revtorpyk for previously treated breast cancer with the PIK3CA mutation. The drug is also being studied for first-line treatment.

“For patients with HR-positive/HER2-negtaive locally advanced or metastatic breast cancer, there is an urgent need for new treatment options that can meaningfully increase the likelihood of survival without disease progression or death,” investigator Sara Hurvitz, MD, of Fred Hutchinson Cancer Center and the University of Washington School of Medicine, said in a news release.  “With the approval of REVTORPYK, oncologists now have an effective new treatment option for these patients.”

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– C. Toni Graham

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– Avijeet Das

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For many women with breast cancer, treatment doesn’t end after the tumor is removed. Decisions about lymph node treatment can have a lasting impact on recovery and quality of life.

Now, new research presented at the 15th European Breast Cancer Conference (EBCC 2026) suggests that radiotherapy may help some patients avoid more extensive lymph node surgery while reducing their risk of lymphedema.

Why Are Lymph Nodes Removed?

Lymph nodes are small glands that help filter harmful substances from the body. During breast cancer surgery, doctors often check the lymph nodes under the arm (called the axillary lymph nodes) to see if cancer has spread.

If cancer is found in these lymph nodes, additional treatment is often recommended. Traditionally, that has meant axillary lymph node dissection (ALND), a surgery that removes many of the lymph nodes from the armpit.

While this procedure can be effective, it also increases the risk of developing lymphedema, a condition that causes swelling in the arm, hand, breast, or chest due to a buildup of lymphatic fluid.

What Did the New Study Find?

Researchers studied women with breast cancer who received chemotherapy or hormone therapy before surgery and still had small amounts of cancer remaining in their sentinel lymph nodes.

Instead of automatically performing a full lymph node dissection, researchers compared two treatment approaches:

• Axillary lymph node dissection (ALND)
• Axillary radiotherapy, which uses targeted radiation to destroy any remaining cancer cells without removing additional lymph nodes

Early results showed that patients treated with radiotherapy experienced lower rates of lymphedema than those who underwent more extensive lymph node surgery.

Researchers also found that cancer control appeared to be similar between the two groups during the early follow-up period, although the study is continuing to evaluate long-term outcomes.

Why This Matters

Lymphedema is one of the most common long-term side effects after breast cancer treatment.

Symptoms may include:

• Swelling in the arm or hand
• A feeling of heaviness or tightness
• Reduced flexibility
• Discomfort or aching
• An increased risk of infection

Although not every patient develops lymphedema, reducing that risk whenever possible can make a meaningful difference in daily life.

If future results continue to support these findings, some patients may be able to receive effective cancer treatment while avoiding a more invasive surgery and lowering their chance of developing lymphedema.

Does This Change Breast Cancer Treatment Today?

Not yet.

These findings are encouraging, but the trial is still ongoing. Researchers will continue following patients for several years to confirm that radiotherapy provides the same long-term cancer control as surgery.

Until then, treatment decisions should always be made with your multidisciplinary care team based on your individual diagnosis, stage of cancer, and personal treatment goals.

Questions to Ask Your Surgeon

If your breast cancer has spread to your lymph nodes, consider asking:

• Do I need additional lymph node surgery?
• Am I a candidate for axillary radiotherapy?
• What is my risk of developing lymphedema?
• How will this treatment affect my long-term recovery?
• Are there newer approaches that may reduce side effects?

Understanding your options before treatment can help you make informed decisions with confidence.

How the Breast Advocate App Can Help

Every breast cancer diagnosis is unique, and so is every treatment plan.

The Breast Advocate App was created to help patients better understand their surgical and treatment options before making important decisions. With personalized, evidence-based education, the app empowers you to prepare for conversations with your healthcare team and ask informed questions about procedures, reconstruction, lymph node management, and recovery.

Knowledge is one of the most powerful tools you can bring to your appointment.

Download the Breast Advocate App and take an active role in your breast cancer journey.

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