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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
What is in development for Breast cancer (all types), drawn from the whole corpus: 131 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
176 medicines on record are linked to one of the types below rather than to Breast cancer (all types) itself. Grouped by the type that holds them; each list opens that type's own page.
The receptor result produces four boxes and the world is organised around three. One report gives a hormone receptor answer and a HER2 answer, and the four combinations are unequal: 70.1 percent hormone receptor-positive HER2-negative, 9.3 percent positive for both, 4.0 percent HER2-positive alone and 10.8 percent triple-negative (SEER 21, 2019 to 2023). Guidelines, trials and patient information are written for three subtypes, so the largest HER2-positive group, the people who are hormone receptor-positive as well, have to read two sets of advice and work out where they overlap.
The classification a report is written against is two years behind the classification in print. The sixth edition of the WHO classification of breast tumours appeared in April 2026 and changed the vocabulary of subtype, pattern and variant, the HER2 reporting categories and the criteria for several types; the UK reporting dataset in force was written against the fifth edition and is due for review in November 2026. Every page in this family, and every report a patient is holding, is currently a fifth-edition document, and there is no mechanism that tells a patient which edition her report was written to.
Stage does not contain grade or the receptors, and the tools that patch the gap disagree with each other. The UK dataset says so in its own words, which is why the Nottingham Prognostic Index and PREDICT exist; America solved the same problem inside the stage number with the AJCC prognostic stage, which the UK dataset advises against using. A British and an American clinician can therefore give the same tumour a different stage, and PREDICT is explicitly less accurate in women under 30, women over 70, tumours over 50 mm, and has never been validated in men.
Receptor conversion is measured but not acted on by evidence. On meta-analysis of 39 paired studies, 22.5 percent of oestrogen receptor-positive primaries had become negative in their metastases and 21.3 percent of HER2-positive ones had, with conversion in the other direction too; NICE asks only that reassessment be considered where it would change management. No prospective study has shown what treating on the metastasis rather than the primary does to survival, so the commonest decision in relapsed breast cancer rests on a biological argument rather than a trial (Schrijver 2018).
Nothing recorded yet.
Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
The measurements underneath every one of these systems are less precise than the decisions they drive. Grade agrees between core biopsy and surgical specimen about 70 percent of the time; the national screening programme's quality assurance scheme finds poor agreement between pathologists on tumour size even on prepared slides; there is no internationally agreed method for scoring oestrogen receptor; and pathologists disagree at the HER2 0 to 1+ boundary that now decides eligibility for an antibody-drug conjugate.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
POSNOC is the only trial in which a woman with a positive sentinel node receives no axillary treatment at all, radiotherapy included; until it reports, every de-escalation result rests on an axilla that was quietly irradiated in nine cases out of ten.
Every partial-breast irradiation trial required pathological nodal staging for eligibility, so the women who now have no sentinel node biopsy under SOUND and INSEMA criteria fall outside the evidence for the radiotherapy they are being offered.
Implant-based reconstruction in the United Kingdom runs above the National Quality Standards on implant loss, infection, reoperation and readmission, and mesh was in majority use for years without a randomised trial; Best-BRA is a pilot, not an answer.
The de-escalation portfolio is inefficient. A systematic review of 97 trials in up to 94,866 participants found multiple studies asking nearly the same question, with patients rarely involved in designing them.
Radiotherapy omission is defined by age thresholds that biology does not respect. LUMINA selected by luminal A biology rather than by age and got a lower recurrence rate than the age-based trials, but the guidelines still key the decision to 65 or 70.
Nothing recorded yet.
Background: Neoadjuvant / adjuvant / perioperative. Also on OnCo: Treatment journeys · Survivorship planner.
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
On EdgeAll 94 changes by month →When this page itself was last checked or edited.
Early-stage HER2+ breast cancer: neoadjuvant (DESTINY-Breast11) and post-neoadjuvant residual disease (DESTINY-Breast05)
Early-stage HER2+ breast cancer (neoadjuvant and post-neoadjuvant)
This is the decision with a deadline. Chemotherapy can stop the ovaries working, temporarily or permanently, and treatment can bring the menopause forward by decades; once treatment has started, some of the options have gone. NICE NG101 (1.1.5) hands fertility preservation to the NICE fertility guideline, now NG257 (2026), and NG257 (1.53.1) says to discuss it with people preparing for treatment likely to impair their fertility, and that where treatment is urgent the discussion should happen at the earliest possible opportunity. The route it names is (1.53.6) oocyte or embryo cryopreservation for people of reproductive age with female reproductive organs, (1.53.5) sperm cryopreservation for those with male reproductive organs, which matters because men get breast cancer too, and (1.53.7) ovarian tissue cryopreservation where the others are not feasible. Two sentences in NG257 are worth carrying into the room. The first is (1.53.3): for NHS-funded fertility preservation, do not apply the eligibility criteria used for conventional fertility treatment, including the lower age limit. The rules about age, existing children and BMI that govern NHS IVF are not supposed to be applied to preserving fertility before cancer treatment. The second is (1.53.4): those criteria will apply later, when you come to use the stored material, so the funding question has two halves and it is worth asking both. Storage is reviewed at least every 5 years and NHS funding continues for people who remain at significant risk (1.53.8). On timing, Cancer Research UK says collecting and freezing eggs takes about 2 to 3 weeks, that IVF is the most effective method, that letrozole or tamoxifen can be used with lower-dose stimulation, and that IVF is available for some people on the NHS but not everywhere, so the answer varies by where you live. Where there is no time for any of that, the other route is switching the ovaries off during chemotherapy with a GnRH agonist injection. In an individual patient-level meta-analysis of 873 patients from five randomised trials, premature ovarian insufficiency occurred in 14.1 percent of those given a GnRH agonist against 30.9 percent of controls (adjusted odds ratio 0.38), and at least one pregnancy after treatment in 10.3 against 5.5 percent, with no significant difference in disease-free or overall survival. The trial that opened this question, POEMS, randomised 257 premenopausal women with operable hormone receptor-negative breast cancer and found ovarian failure at 2 years in 8 percent on goserelin against 22 percent, with pregnancy in 21 against 11 percent. Whether this is offered as well as, or instead of, egg freezing is a conversation for the fertility clinic rather than a substitute for it. If the menopause arrives anyway, it arrives fast and without the years of warning a natural menopause gives. NICE NG101 (1.14.20) says to offer women information and counselling about the possibility of early menopause and its symptoms, and (1.14.21) to stop systemic HRT at diagnosis. On treating the symptoms it is restrictive and says so: (1.14.22) do not routinely offer HRT to women with a history of breast cancer; (1.14.23) offer it in exceptional circumstances for severe symptoms after discussing the risks; (1.14.24) consider an SSRI for hot flushes, but not for women taking tamoxifen; and (1.14.25) do not offer soy, red clover, black cohosh, vitamin E or magnetic devices. Bone follows: (1.14.26) offer a baseline DEXA scan to women not on adjuvant bisphosphonates who are starting an aromatase inhibitor, have a treatment-induced menopause, or are starting ovarian suppression; (1.14.27) not to those on tamoxifen alone; and (1.14.28) bisphosphonates for those the UK expert group algorithms identify. Whether it is safe to pause endocrine therapy to try for a baby is a question for hormone receptor-positive disease and is answered on that page.
Published 3 July 2025 and recommended from 1 January 2026. For breast the classification is unchanged; the yp classification is clarified, basing ypT on the largest continuous focus of residual invasive cancer and recommending that the residual cancer burden be reported beside it.
Published April 2026. Reserves 'variant' for molecular alterations and separates subtype from pattern, updates the HER2 reporting categories so that no membrane staining is distinguished from any, recognises lobular carcinoma with extracellular mucin, moves high-grade and receptor-negative mucinous carcinomas into no special type, drops the unified neuroendocrine model for the breast, and lowers malignant phyllodes tumour to four of five adverse criteria.