Estrogens, Conjugated

The ItovebiTM (inavolisib)-based regimen reduced the risk of death by more than 30% in people with PIK3CA-mutated HR-positive, HER2-negative advanced breast cancer, compared with palbociclib and fulvestrant alone1 The PIK3CA mutation is found in approximately 40% of HR-positive advanced breast cancers and is associated with a poor prognosis2,3 New data are being presented in an oral session at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting and published in the New England Journal of Medicine1 31 May 2025 - Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today positive final results from the overall survival (OS) analysis of the phase III INAVO120 study. These data showed ItovebiTM (inavolisib), in combination with palbociclib (Ibrance®) and fulvestrant, reduced the risk of death by more than 30% compared with palbociclib and fulvestrant alone. This represents a statistically significant and clinically meaningful improvement in overall survival for people with PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, endocrine-resistant, locally advanced or metastatic breast cancer.1 The results are being presented in an oral session at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting and simultaneously published in the New England Journal of Medicine (NEJM).1"For the first time, a PI3K pathway-targeted drug has shown it can help people with this breast cancer subtype live longer," said Levi Garraway, M.D., Ph.D., Roche’s Chief Medical Officer and Head of Global Product Development. "Itovebi exemplifies our continued commitment to improve survival rates for people with this common PIK3CA mutation, for whom more effective treatment options are needed.” “The landmark data for the inavolisib-based regimen showed not only a doubling in progression-free survival, but importantly that it extended lives and gave people more time without chemotherapy,” said Professor Nicholas Turner, Lead Study Author and Professor of Molecular Oncology at The Institute of Cancer Research, and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, London, United Kingdom. “These results give us confidence that this regimen could become the new standard of care in the first-line setting, having demonstrated a substantial benefit on patient outcomes and quality of life.” The Itovebi-based regimen demonstrated a meaningful OS benefit compared with palbociclib and fulvestrant alone.1 The median OS was 34.0 months (95% CI: 28.4–44.8) for people in the Itovebi arm, compared with 27.0 months (95% CI: 22.8–38.7) in the palbociclib and fulvestrant arm (stratified hazard ratio [HR]=0.67; 95% CI: 0.48–0.94, p-value=0.0190 [boundary=0.0469]).1 The benefit seen in delaying cancer progression was maintained in the updated analysis, with the Itovebi-based regimen showing a consistent improvement in median progression free survival of 17.2 months versus 7.3 months (stratified HR=0.42; 95% CI: 0.32-0.55) in the comparator arm.1 The Itovebi-based regimen also led to a statistically significant improvement in objective response rate (the percentage of patients whose signs of cancer completely disappear or their tumours shrink significantly after treatment) and ad-hoc exploratory analyses showed it substantially delayed time to chemotherapy by approximately two years (stratified HR=0.43; 95% CI: 0.30-0.60).1 No new safety signals were observed at the time of the final OS analysis, with a low discontinuation due to adverse events supporting good tolerability.1 The Itovebi-based regimen is approved in the United States, Switzerland, Canada, Australia, United Arab Emirates and China. In May, it received a positive opinion from the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP), with a final decision regarding the approval expected from the European Commission in the near future. Data from the INAVO120 study are currently under review with other global health authorities. Beyond INAVO120, Itovebi is currently being investigated in three company-sponsored phase III studies (INAVO121, INAVO122, INAVO123), all in PIK3CA-mutated, locally advanced or metastatic breast cancer in various combinations.4-7 We are exploring additional studies in breast cancer and other tumour types with the hope of providing the benefit of this targeted therapy to more people with PIK3CA mutations. Itovebi is an oral, targeted treatment that has been shown to provide well-tolerated and durable disease control in people with PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor 2-negative, advanced breast cancer, who often have a poor prognosis and are in urgent need of new treatment options.2,3,8 Itovebi has been designed to help minimise the overall burden and toxicity of treatment and is differentiated from other PI3K inhibitors due to its high potency and specificity for the PI3K alpha isoform versus other isoforms, and unique mechanism of action that facilitates the degradation of mutated PI3K alpha.9,10 The INAVO120 study [NCT04191499] is a phase III, randomised, double-blind, placebo-controlled study evaluating the efficacy and safety of Itovebi™ (inavolisib) in combination with palbociclib and fulvestrant versus placebo plus palbociclib and fulvestrant in people with PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer whose disease progressed during treatment or within 12 months of completing adjuvant endocrine therapy and who have not received prior systemic therapy for metastatic disease.4 The study included 325 patients, who were randomly assigned to either the investigational or control treatment arm.4 The primary endpoint is progression-free survival, as assessed by investigators, defined as the time from randomisation in the clinical trial to the time when the disease progresses, or a patient dies from any cause.4 Secondary endpoints include overall survival, objective response rate, and clinical benefit rate.4 Beyond INAVO120, Itovebi is currently being investigated in three additional company-sponsored phase III clinical studies in PIK3CA-mutated locally advanced or metastatic breast cancer in various combinations:5-7 in combination with fulvestrant versus alpelisib plus fulvestrant in HR-positive/HER2-negative breast cancer post cyclin-dependent kinase 4/6 (CDK4/6) inhibitor and endocrine combination therapy (INAVO121; NCT05646862). in combination with pertuzumab plus trastuzumab for subcutaneous injection (SC) versus pertuzumab plus trastuzumab for SC and optional physician's choice of endocrine therapy as a maintenance treatment in HER2-positive disease (INAVO122; NCT05894239). in combination with CDK4/6 inhibitor and letrozole versus placebo plus a CDK4/6 inhibitor and letrozole in the first-line setting in PIK3CA-mutated HR-positive/HER2-negative, endocrine-sensitive breast cancer (INAVO123; NCT06790693). HR-positive breast cancer is the most prevalent type of all breast cancers, accounting for approximately 70% of cases.11,12 A defining feature of HR-positive breast cancer is that its tumour cells have receptors that attach to one or both hormones – oestrogen or progesterone – which can contribute to tumour growth. People diagnosed with HR-positive metastatic breast cancer often face the risk of disease progression and treatment side effects, creating a need for additional treatment options.12-14 The PI3K signalling pathway is commonly dysregulated in HR-positive breast cancer, often due to activating PIK3CA mutations, which have been identified as a potential mechanism of intrinsic resistance to standard of care endocrine therapy in combination with cyclin-dependent kinase 4/6 inhibitors.3 Roche has been advancing breast cancer research for more than 30 years with the goal of helping as many people with the disease as possible. Our medicines, along with companion diagnostic tests, have contributed to bringing breakthrough outcomes in human epidermal growth factor 2-positive and triple-negative breast cancers. As our understanding of breast cancer biology rapidly improves, we are working to identify new biomarkers and approaches to treatment for other subtypes of the disease, including oestrogen receptor-positive breast cancer, which is a form of hormone receptor-positive breast cancer, the most prevalent type of all breast cancers.11,12 Founded in 1896 in Basel, Switzerland, as one of the first industrial manufacturers of branded medicines, Roche has grown into the world’s largest biotechnology company and the global leader in in-vitro diagnostics. The company pursues scientific excellence to discover and develop medicines and diagnostics for improving and saving the lives of people around the world. We are a pioneer in personalised healthcare and want to further transform how healthcare is delivered to have an even greater impact. To provide the best care for each person we partner with many stakeholders and combine our strengths in Diagnostics and Pharma with data insights from the clinical practice. For over 125 years, sustainability has been an integral part of Roche’s business. As a science-driven company, our greatest contribution to society is developing innovative medicines and diagnostics that help people live healthier lives. Roche is committed to the Science Based Targets initiative and the Sustainable Markets Initiative to achieve net zero by 2045. Genentech, in the United States, is a wholly owned member of the Roche Group. Roche is the majority shareholder in Chugai Pharmaceutical, Japan. References [1] Turner NC, et al. INAVO120 Phase III trial final overall survival (OS) analysis of first-line inavolisib (INAVO)/placebo (PBO) + palbociclib (PALBO) + fulvestrant (FULV) in patients (pts) with PIK3CA-mutated, hormone receptor-positive (HR+), HER2-negative (HER2–), endocrine-resistant advanced breast cancer (aBC). Presented at the American Society of Clinical Oncology (ASCO) Annual Meeting, 2025 May 30-June 03; Chicago, USA. Abstract #1003. [2] Fillbrunn M, et al. PIK3CA mutation status, progression and survival in advanced HR+/HER2- breast cancer: a meta-analysis of published clinical trials. BMC Cancer. 2022;22(1):1002. [3] Anderson E, et al. A Systematic Review of the Prevalence and Diagnostic Workup of PIK3CA Mutations in HR+/HER2– Metastatic Breast Cancer. Int J Breast Cancer. 2020;2020:3759179. [4] ClinicalTrials.gov. A Study Evaluating the Efficacy and Safety of Inavolisib + Palbociclib + Fulvestrant vs Placebo + Palbociclib + Fulvestrant in Patients With PIK3CA-Mutant, Hormone Receptor-Positive, Her2-Negative, Locally Advanced or Metastatic Breast Cancer (INAVO120) [Internet; cited 2025 May]. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT04191499. [5] ClinicalTrials.gov. A Study Evaluating the Efficacy and Safety of Inavolisib Plus Fulvestrant Compared With Alpelisib Plus Fulvestrant in Participants With HR-Positive, HER2-Negative, PIK3CA Mutated, Locally Advanced or Metastatic Breast Cancer Post CDK4/6i and Endocrine Combination Therapy (INAVO121) [Internet; cited 2025 May]. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT05646862. [6] ClinicalTrials.gov. A Study to Evaluate the Efficacy and Safety of Inavolisib in Combination With Phesgo Versus Placebo in Combination With Phesgo in Participants With PIK3CA-Mutated HER2-Positive Locally Advanced or Metastatic Breast Cancer (INAVO122) [Internet; cited 2025 May]. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT05894239. [7] ClinicalTrials.gov. A Study Evaluating the Efficacy and Safety of Inavolisib Plus CDK4/​6 Inhibitor and Letrozole vs Placebo + CDK4/​6i and Letrozole in Participants With Endocrine-Sensitive PIK3CA-Mutated, Hormone Receptor-Positive, HER2-Negative Advanced Breast Cancer (INAVO123) [Internet; cited 2025 May]. Available from: https://clinicaltrials.gov/study/NCT06790693. [8] Turner NC, et al. Inavolisib-Based Therapy in PIK3CA-Mutated Advanced Breast Cancer. NEJM. 2024;391(17):1584-96. [9] Juric D, et al. A phase I/Ib study of inavolisib (GDC-0077) in combination with fulvestrant in patients (pts) with PIK3CA-mutated hormone receptor-positive/HER2-negative (HR+/HER2–) metastatic breast cancer. Presented at San Antonio Breast Cancer Symposium, 2020 December 7-10; San Antonio, USA. Abstract #P5-17-05. [10] Hong R, et al. GDC-0077 is a selective PI3K alpha inhibitor that demonstrates robust efficacy in PIK3CA mutant breast cancer models as a single agent and in combination with standard of care therapies. Cancer Res. 2018;78(4):4-14. [11] National Cancer Institute: Surveillance, Epidemiology and Ends Result Program. Cancer Stat Facts: Female Breast Cancer Subtypes [Internet; cited 2025 May]. Available from: https://seer.cancer.gov/statfacts/html/breast-subtypes.html. [12] Lim E, et al. The natural history of hormone receptor-positive breast cancer. Oncology (Williston Park). 2012;26(8):688-94,696. [13] Tomas R and Barrios CH. Optimal management of hormone receptor positive metastatic breast cancer in 2016. Ther Adv Med Oncol. 2015;7(6):304-20. [14] Galipeau N, et al. Understanding key symptoms, side effects, and impacts of HR+/HER- advanced breast cancer: qualitative study findings. J Patient-Rep Outcomes. 2019;3(1):10. The content above comes from the network. if any infringement, please contact us to modify.

A powerful new drug for advanced breast cancer can be used to treat emerging tumours, months before they have a chance to grow, helping to keep patients well for longer and delaying the need for later-line therapies including chemotherapy. Results of a global study, funded by AstraZeneca and co-led by researchers at The Institute of Cancer Research, London, The Royal Marsden NHS Foundation Trust and Institut Curie, Paris, were presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago on 1 June 2025. The results found that patients with advanced hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) breast cancer who were given the new drug, called camizestrant, in combination with a CDK4/6 inhibitor cut the chances of their cancer getting worse by over half (56 per cent), allowing them to stay on first-line therapy for longer. The SERENA-6 phase III trial is also the first global trial to demonstrate that using circulating tumour DNA (ctDNA) blood tests to guide treatment at the right time — before clinical signs of progression appear — has a significant clinical benefit for this group of patients. Findings from the trial were simultaneously published in The New England Journal of Medicine. Experts now hope the findings have the potential to become a new treatment strategy for patients with this common type of advanced breast cancer. Around 55,000 women are diagnosed with breast cancer in the UK every year and 11,500 will die from the disease. Around 70 per cent of patients have HR+, HER2- breast cancer. Some patients go on to develop mutations in a gene called ESR1 gene, which programmes the oestrogen receptor, allowing the cancer to grow and resist hormone-blocking treatments. Although ESR1 mutations are rare at diagnosis of advanced breast cancer, they emerge during first-line therapy in around 40 per cent of patients. First-line therapy for HR+, HER2‑ advanced breast cancer is usually a cyclin-dependent kinase (CDK) 4 and 6 inhibitor drug plus an aromatase inhibitor (a type of hormone treatment). If this treatment fails, chemotherapy can be an option but delaying this is highly important for patients because of the toxic side effects it brings. Camizestrant, which was discovered and developed by AstraZeneca, is a type of drug described as a ‘next-generation’ oral selective estrogen receptor degrader (SERD). It works by blocking and breaking down oestrogen receptors in breast cancer cells. Camizestrant was designed to target the ESR1 mutations tested for in the ctDNA blood tests. Camizestrant not only prevents oestrogen from attaching to cancer cells but also destroys the receptors themselves, making it harder for the cancer to resist treatment. The SERENA-6 study tested whether switching to camizestrant from an aromatase inhibitor, whilst continuing treatment with the same CDK 4/6 inhibitor to treat tumours with emerging ESR1 mutations could extend the benefit of first line treatment and delay the need for later-line therapies. To be eligible to take part in the study, 3,325 patients with HR+, HER2 negative advanced breast cancer (who had been on first-line treatment for at least six months) from 23 countries were screened for ESR1 mutations using ctDNA testing every 8-12 weeks. Of that number, 548 patients tested positive for ESR1 mutations during the screening period, and 315 were randomised onto the study. Half of the patients were given camizestrant, alongside their CDK4/6 inhibitor plus a dummy pill instead of their aromatase inhibitor. Patients on the control arm continued with their aromatase inhibitor and CDK4/6 inhibitor plus a dummy pill instead of camizestrant. The results showed that the camizestrant combination reduced the risk of breast cancer progression or death by over half (56 per cent), based on the reported hazard ratio of 0.44. The median progression free survival time for patients taking the camizestrant combination was 16 months, compared with 9.2 months for patients on the control arm. The camizestrant combination was well tolerated, with only a few patients (1 per cent) experiencing side effects that led them to discontinue the treatment. The results also showed that the therapy regime reduced the risk of a deterioration in patients’ general health and quality of life by 47 per cent (based on the reported hazard ratio of 0.53), compared with the control group, demonstrating the benefit of patients remaining on first-line therapy. The Breast Cancer Clinical Trials Team that co-led the SERENA-6 trial are based in the Ralph Lauren Research Wing, Kuok Research Centre within the Oak Cancer Centre, which was funded by The Royal Marsden Cancer Charity. Scientists working in the Breast Cancer Now Toby Robins Research Centre at the ICR and The Ralph Lauren Centre for Breast Cancer Research at The Royal Marsden, funded by The Royal Marsden Cancer Charity, and The National Institute for Health and Care Research Royal Marsden Biomedical Research Centre, have been leading pioneering research into the use of liquid biopsies to detect breast cancer relapse and guide treatment for more than a decade. Co-principal investigator Professor Nick Turner, Professor of Molecular Oncology at The Institute of Cancer Research, London, and Director of Clinical Research and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, said: “This is a pivotal moment in breast cancer care. These results demonstrate that using liquid biopsy blood tests to spot emerging resistance in tumours, before they start to grow and make the patient unwell, can guide early intervention with camizestrant to delay disease progression in patients with ESR1 mutations. “This proactive approach not only extends the benefit of first line therapy but also redefines how we think about drug resistance in this type of breast cancer. This is a potential new treatment strategy in oncology to treat developing resistance before it causes disease progression. “Ongoing trials are also examining the use of camizestrant in broader first-line populations from the start of their treatment, as well as in the early breast cancer setting, to determine how best to integrate camizestrant into long-term treatment strategies to benefit breast cancer patients.” Professor Kristian Helin, Chief Executive of The Institute of Cancer Research, London, said: “The results of the SERENA-6 trial represent more than a clinical milestone – they represent a transformational shift in how we approach precision medicine. "The Institute of Cancer Research has played a major role in advancing ctDNA testing for breast cancer, particularly in early detection and relapse prediction – so it is very exciting to see this technology being used to delay disease progression in patients and extend the benefits of first-line treatment in patients with this type of advanced breast cancer and delay the need for chemotherapy for as long as possible. “These breakthroughs are helping shape personalised breast cancer treatment, allowing doctors to adjust therapies earlier and improve patient outcomes.” Professor Nicholas van As, Chief Medical Officer at The Royal Marsden NHS Foundation Trust, said: “Innovative ctDNA trials at The Royal Marsden have transformed the way clinicians tailor cancer treatments and detect relapse in patients before clinical signs of progression appear. “It is hugely exciting that the SERENA-6 trial has evolved this thinking and clinicians can use it to personalise kinder treatments regimes for this group of patients and improve their outcome.”