A review of metastatic breast cancer in 2024

It’s been an encouraging year in the field of metastatic breast cancer (mBC), with promising developments that could shift the dial of patient care. Advances in screening, diagnostics and therapeutics continue to rewrite clinical practice, while important changes to the culture that surrounds mBC – and the communications that contribute to it – are redefining experiences for people living with the disease. 13^th October was Metastatic Breast Cancer Awareness Day, providing us with an opportune moment to review the headline developments in metastatic/advanced breast cancer in 2024, and what they might mean for the future of mBC care.

These are the highlights from our team of mBC communications experts, including Claire Gillis, Jason Gloye, Nichole Davies, Susanne Bobadilla, Sarah-Jane Barker and Alex Lewis.

#1. Therapeutic advances

Several therapeutic advances in mBC, including a host of new treatment options, have cut through in 2024, offering new hope to patients. Studies presented at ASCO and ESMO reveal impressive gains across a range of breast cancer subtypes:

Oral SERDS are set to impact treatment of hormone receptor-positive advanced breast cancer. Oral selective oestrogen receptor degraders are providing a novel approach to addressing treatment resistance in HR+ breast cancer. Data from the phase III EMARALD trial shows that the first oral SERD to be approved – elacestrant – significantly improves progression-free survival (PFS) in patients with ESR1-mutant breast cancer, compared to traditional endocrine therapies. Elacestrant is already approved in second line for those with estrogen receptor mutation ESR1m, but additional next generation SERDs are in development for first-line metastatic breast cancer in combination with CDK4/6 inhibitors to maximize endocrine therapy.

Immunotherapy is transforming patient management in difficult-to-treat advanced breast cancers, improving outcomes as monotherapies, neoadjuvant and adjuvant therapies. For example, in advanced triple-negative breast cancer, neoadjuvant pembrolizumab followed by adjuvant pembrolizumab monotherapy significantly prolongs overall survival (OS).

Antibody-drug conjugates (ADCs) could become the new standard of care:

Primary results from the phase IIIb/IV, open-label DESTINYBreast-12 trial reported that trastuzumab deruxtecan showed substantial and durable efficacy in patients with HER2-positive metastatic breast cancer, including those with brain metastases.
A novel ADC targeting HER3 in metastatic hormone-sensitive breast cancer is yielding encouraging results according to early data from the ICARUS-BREAST01 study. HER3 positivity in breast cancer is associated with poor prognosis.

M BC patients — A filming break for the stars of Gilead’s Paintings of Hope campaign. This campaign led to shorter approval times for drugs in Spain, including those used to treat mBC.

Triple combination could be a good option in HR+/HER2-negative PIK3CA-mutant breast cancer. Data from the phase 3 INAVO120 trial suggests the triple combination of inavolisib plus palbociclib and fulvestrant reduces the risk of progression or death in patients with PIK3CA-mutated hormone receptor-positive HER2-negative mBC. Inavolisib received FDA Breakthrough Therapy Designation for PIK3CA-Mutated, HR+/HER2– Breast Cancer back in May, and has since been granted a priority review for a new drug application. The FDA is scheduled to decide on the application next month.

Abemaciclib improves progression-free survival in certain metastatic breast cancers. Results from the postMONARCH study show that people with metastatic hormone-receptor-positive, HER2-negative breast cancer who received abemaciclib plus fulvestrant lived longer without the cancer growing than those who received fulvestrant alone. The study included people who had previously experienced cancer growth while taking a CDK4/6 inhibitor and an aromatase inhibitor.

Trastuzumab deruxtecan is an effective new option for some metastatic HER2-low and -ultralow breast cancers. Data from the DESTINY-Breast06 study suggests trastuzumab deruxtecan offered better PFS and response rate than chemotherapy for metastatic, hormone-receptor-positive, HER2-low and HER2-ultralow breast cancer that had grown during hormonal therapy treatment. People with metastatic HER2-low and -ultralow breast cancer who received trastuzumab deruxtecan lived about 13 months without the cancer growing. People who received chemotherapy lived about 8 months before the cancer grew.

UK HTA body sending mixed messages on mBC.

In January 2024, NICE reversed its earlier draft decision not to recommend talazoparib for adults with BRCA 1 or 2 mutated HER2-negative locally advanced or metastatic breast cancer after prior chemotherapy. Final draft guidance recommended using talazoparib instead of chemotherapy.
However, in March 2024, NICE issued final draft guidance that didn’t recommend trastuzumab deruxtecan for treating advanced HER2-low breast cancer in adults. Breast Cancer Now described the decision as ‘devastating’.

Organisations are increasingly looking to harness AI to accelerate early detection and diagnosis in breast cancer.

#2. Advances in screening & diagnosis

With early diagnosis critically important in breast cancer – it’s associated with better prognosis, better (and less aggressive) treatment options and higher survival rates – developments in screening and diagnostics continue to offer hope. Highlights in 2024 include:

Breast cancer screening in the US to begin earlier. The U.S. Preventive Services Task Force updated its guidelines in April, recommending women begin regular mammograms at age 40, rather than the previous guideline of 50. This change aims to catch breast cancer earlier, which is associated with better prognosis, better (and less aggressive) treatment options and higher survival rates. Additionally, the FDA has mandated that mammogram reports now include information on breast density, as denser breast tissue can obscure tumors and increase cancer risk.

Early genetic testing is linked to better survival for younger women with BRCA mutation. According to a study, women aged 40 years or younger who tested positive for a BRCA mutation before being diagnosed with breast cancer were more likely to be diagnosed with smaller and less invasive cancers than those who tested positive for BRCA after a breast cancer diagnosis. Women who had the genetic testing done before being diagnosed with breast cancer were also more likely to live longer and without cancer coming back. Study authors say the findings highlight the importance of “genetic counselling and testing to inform not only prevention, but tailored earlier detection, treatment, and follow-up strategies once diagnosed.”

Organisations are increasingly looking to harness AI to accelerate early detection and diagnosis in breast cancer through partnership, collaboration and innovation:

The most recent example is the announcement of a partnership between AZ and biotech company, Owkin, to develop an AI tool to identify breast cancer mutations. The companies are collaborating to develop an AI-powered breast cancer pre-screening tool that can identify germline BRCA (gBRCA) mutations from digitised pathology slides, potentially shortening the diagnostic process from months to under one hour.
In the UK, NHS Grampian has this year piloted a new AI breast screening programme – Mia (from Kheiron Medical Technologies) – to identify tiny signs of breast cancer that would be otherwise difficult to spot with the human eye. The tool, funded by the UK government, successfully highlighted all cases where breast cancer was evident.

Pharma companies (and health providers) are making deliberate efforts to reframe the narrative of mBC to focus on ‘living’ not just ‘surviving’.

#3. Step change in culture & communications in mBC

There’s growing evidence that the culture surrounding mBC is changing. Historically, people with metastatic or advanced breast cancer have described a culture focused on ‘survivorship’ – with many patients feeling isolated, undervalued and written off (even by the clinicians responsible for their care). 2024 has seen renewed efforts to change that culture, with communications playing an important role.

The language of cancer is changing. Pharma companies (and health providers) are making deliberate efforts to reframe the narrative of mBC to focus on ‘living’ not just ‘surviving’. We can see this in breast cancer through creative campaigns in countries where legislation allows promotion to non-healthcare professional, such as the direct to consumer (DTC) campaign for Enhertu in the USA.

The first-ever DTC campaign for Enhertu – Not Today – launched on Amazon Prime Video during Thursday Night Football. It depicts metastatic cancer patients’ experiences more authentically - “happy moments” are offset against a background of more contemplative, serious reflections. The campaign is designed to meet patients where they are at and paint a more realistic picture of living with MBC.

Communications are now focusing on the lived experience. The positive shift in focus from surviving to living is being reinforced by greater emphasis on the patient (or person) experience, to accurately reflect what life is like for people with breast cancer. This continues the direction of travel set out by campaigns. Examples taken from our project portfolio include: Paintings of Hope, The Cancer Currency and “I Am Advanced Breast Cancer”.

The Cancer Currency, launched by Europa Donna & VML in February 2024, helped secure recognition and funding for mBC within Europe’s Beating Cancer Plan. The campaign was created to highlight that people living with mBC have value and demand greater investment into the disease. As part of the campaign, a suite of banknotes was created to celebrate the stories of 5 women and the years they have lived with mBC. Its purpose was to make sure that those living with mBC are not only counted, they’re valued. The Cancer Currency is a great example of patient advocacy in action, and how VML Health works with patients to drive meaningful change.

Consumer industries are stepping up in breast cancer. Understanding that lived experience – and the impact breast cancer has on everyday lives, beyond the disease itself – is leading to innovation in sectors outside of health. The most recent example from our project portfolio is in primary breast cancer with Ford’s introduction of the SupportBelt, a seatbelt accessory to help people who have undergone mastectomy.

Communications between oncologists and patients has a big impact on outcomes. A presentation at ASCO this year showed that oncologist communication is important for treatment completion in breast cancer. Patients who thought their providers were poor communicators were found to be less likely to stick with their treatment, according to a survey of nearly 1,000 members of the Breastcancer.org community. Though the findings relate to all breast cancer types, it’s particularly applicable to mBC where patients sometimes feel that interactions with their oncologists/physicians are inhumane.

A culture of diversity is finally establishing itself in breast cancer research. The importance of diversity in clinical trials has always been relevant in breast cancer, where major disparities in outcomes in so-called minority populations is often linked to poor representation in trials. 2024 has shown that achieving diversity in clinical trials is an industry priority, with an increasing number of initiatives dedicated to it (as seen at ASCO and ESMO). This appears to be bearing fruit – as evidenced by studies presented at ASCO this year, including research that showed:

Black women with early-stage breast cancer who received the chemotherapy medicine docetaxel every three weeks had less peripheral neuropathy than Black women who received the chemotherapy paclitaxel.
Polygenic risk score may better predict the risk of triple-negative breast cancer in young Black women.

One in three patients living with mBC don’t know what type of breast cancer they have, and this is causing confusion and damaging their confidence in managing their condition.

2024: a year of great promise in mBC… with an important caveat

The developments outlined above, along with many more that didn’t make the cut, reflect an encouraging year in the field of metastatic breast cancer. Advances in science, along with significant improvements in screening and diagnostics, can only have a positive impact for patients. Moreover, with more innovation on the way, and a more positive focus on living not just surviving, the future of mBC care looks promising. However, according to recent research, one key aspect of the mBC experience will need to improve if we’re to maximise the value of therapeutic innovation: the information given to mBC patients to help them understand their diagnosis.

A global survey by The ABC Global Alliance in partnership with AstraZeneca, reveals that many mBC patients are unhappy with the information provided by their HCPs at diagnosis, in particular, complex language around biomarkers. It shows that one in three patients living with mBC don’t know what type of breast cancer they have, and this is causing confusion and damaging their confidence in managing their condition.

This finding underlines the importance of communications in cancer and the influence it can have on patient outcomes. Moreover, it highlights a big opportunity to further improve care in mBC as we look ahead towards 2025. To that end, we’re continuing to work closely with ABC Global Alliance to identify unmet needs and ascertain progress towards their goals for change in mBC. That work is well underway and will provide an important, real-world baseline for future communications.