The rejection of camizestrant at ODAC last week was sharp and pointed.

Sharp Samurai swords. Source: Kyoto museum

Vepdegestrant’s FDA approval a day later was even sharper.

AstraZeneca challenged the paradigm, catching ESR1 mutations early via ctDNA in patients without radiographic progression, shifting treatment while still on the CDK4/6i backbone.

Arvinas played it safe with a more traditional 2L setting, but ended up with a lower PFS than what was already approved. The irony cuts both ways.

Welcome to the contradictions defining the breast cancer landscape where regulatory logic collides with clinical biology, and boldness gets punished while unremarkable gets the nod.

As we head into American Society of Clinical Oncology (ASCO) annual meeting, it’s time for another preview as we look at what stands out and which agents are emerging…

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