Editor's Note: On the international stage of breast cancer research, Professor Michael Gnant from the Comprehensive Cancer Center of the Medical University of Vienna, Austria, has become a highly respected authority with his profound academic expertise and outstanding leadership. He has not only achieved significant accomplishments in academic research but also actively engaged in international exchanges and cooperation, making important contributions to the global development of breast cancer treatment. At the 2024 SABCS conference, Professor Michael Gnant presided over important sessions and commented on several cutting-edge research findings, bringing new insights into the treatment of breast cancer. At the SABCS conference, Oncology Frontier conducted a special interview with Professor Michael Gnant, inviting him to share the latest developments and future trends from the conference.Oncology Frontier: You and Professor Zhimin Shao jointly presided over the General Session 2 of this conference. As the moderator of this session, could you please give us an overview of the main content and highlights of this segment?
Professor Michael Gnant: First of all, I was delighted and honored for the opportunity to moderate this important and breakthrough session at the San Antonio Breast Cancer Symposium together with my friend Professor Zhimin Shao from Fudan. It was a great session. It started with an interim analysis of the EUROPA trial, which is a trial of radiotherapy or endocrine treatment for low-risk patients. Two-year follow-up is not too long, but this is a significant trial, also looking at quality of life and indicating that modern radiotherapy is actually very well tolerated. This paper is also published in the Lancet today, so that also indicates the importance.
We then had two other trials looking at low-risk DCIS, doing the traditional treatment, surgery plus radiotherapy versus active monitoring. Now, this is a very innovative trial. Personally, I find it’s a lot of de-escalation because we obviously have established treatment for DCIS. As a matter of fact, more than 30% of patients actually switched from the arm they have been assigned to. It indicates that there is not too much difference, but I don’t think that that is mature for routine clinical practice. Also, we saw a very provocative 10-year analysis of the SUPREMO trial, radiotherapy after mastectomy for patients with 1, 2, 3 involved lymph nodes. In short, it showed that there is no overall survival difference there, which is somewhat in contrast with previous reports. There will be a lot of discussion about post-mastectomy radiotherapy.
Probably most important was the presentation of the INSEMA trial. This randomized sentinel node biopsy versus no axillary surgery whatsoever. At least for now, we can say, not very surprisingly, that if you select your patients carefully, older patients, low-grade patients, low-risk DCIS, that this is something that we can consider leaving out even the sentinel node biopsy. Very similar to the SOUND trial that has been presented in last year’s St. Gallen meeting by Dr. Gentilini. But INSEMA is much larger and the quality of the data is impressive. So I think this is practice changing in a way that for very low-risk patients, it’s probably safe to leave the axilla alone. This paper is today published in the New England Journal of Medicine, which is obviously also appreciating the importance of this work.
Oncology Frontier：You have visited China many times to participate in academic exchanges in the field of breast cancer. Can you share your observations on the main differences in the treatment of breast cancer patients between China and your country? At the same time, what do you think are the reasons behind these differences?
Professor Michael Gnant:I love China. I’m in China a lot. I visited just a couple of months ago quite a number of cities and I have many friends there. I hold visiting professorships in several institutions. China is progressing massively. However, there are differences. For example, early detection is still a problem. So population-based screening is obviously much easier in a country like Austria, where we have fewer inhabitants than most Chinese major cities. But I think the relatively later detection still also leads to an excess in mastectomy. Nationwide, the breast conservation rate in China is approaching 30%, which is up from a few years ago, but it’s still not there where it should be. Like in my country, it’s almost 80%. However, I believe there’s a lot of really very impressive research going on at the leading Chinese institutions. And now, if also clinical trials that are currently developed by CSCO and by the CACA framework with many of very distinguished leaders in the field, China will catch up very soon. And also hopefully open up a little bit in a way that contribution to global and international research collaborations, not only with companies but also with other academic groups, will develop in the years to come. But in general, I think China is on a great way to even better serve the patients than they do now.
Oncology Frontier: What research has impressed you most in this SABCS conference? Could you give us a brief introduction of these research results and their significance?
Professor Michael Gnant:I think what was very impressive yesterday is the presentation of the EMBER-3 trial. That is a trial of a new SERD imlunestrant in combination with abemaciclib or as monotherapy. And very interesting in that developing field of selective estrogen receptor downgraders, imlunestrant appears to be very effective both as monotherapy, particularly in ESR1 mutated disease. However, in the combination with abemaciclib, the effect appears to be independent of the mutation status of ESR1, which is, number one, interesting from a scientific point of view and also offers an excellent treatment option for patients who might not have access to molecular testing.
Oncology Frontier: The 19th St.Gallen International Breast Cancer Conference (SGBCC) will be held in Vienna, Austria in March 2025. As the highly respected president of the SGBCC, could you please tell us some highlights and features of the preparatory work in advance, so that we are full of expectations for this grand event?
Professor Michael Gnant:Yes, the St. Gallen International Breast Cancer Conference is probably the most important highlight meeting and also summit of the consensus conference on Saturday where the voting takes place. And it defines the standard of care because whatever has been published in between will be related into clinical practice, what is the new standard of care by these votings and by the subsequent manuscript. Now, next year we expect around 5,000 participants from more than 100 countries in the world and I’m very optimistic that also many Chinese physicians will have the ability to attend. We have a partnership with CSCO. There will be special programs like we call it the Voice of China session and there will be a China launch directed at our colleagues from China. For the first time we have four panelists from China which is obviously also a signal that interaction with physicians and scientists in China is very important for us in the St. Gallen conference in Vienna.
