Dr Premji Discusses Exciting Advances and Unmet Needs in Breast Cancer

In recognition of October as Breast Cancer Awareness Month, Targeted Oncology spoke with Sarah Premji, MD, to discuss the evolving landscape of breast cancer treatment.

Premji was recently appointed assistant director of breast cancer research at Sarah Cannon Research Institute (SCRI) in Nashville, Tennessee.¹ Premji was a recipient of the 2025 American Society of Clinical Oncology Conquer Cancer Young Investigator Award.

Here, Premji discusses her new role, what she’s most excited about in breast oncology, and the unmet needs that persist in the field.

Targeted Oncology: What are you most excited about in your new role?

Sarah Premji, MD: I would say one of the biggest things that drew me to SCRI was its dedication to advancing care in the community through clinical trials. We know that SCRI is a global leader in oncology research, and that ultimately, 80% of patients who are faced with a cancer diagnosis get their care in the community. So, being able to facilitate trials that are led and conducted in the community so that patients have access to the latest drugs, innovations, and developments is incredibly important.

Then, of course, being able to work with community-based providers who now have the opportunity to learn about drug management in the event of future potential approvals, I believe that allows for more seamless integration of these novel agents into community practice. SCRI has been devoted to multidisciplinary, patient-centered care and advancing science through clinical research. These were things that really resonated with me, as well as having the opportunity to learn from so many leaders who are so well-respected in their fields and have contributed in so many meaningful ways.

How has the field of breast cancer research evolved?

I would say that over the past few years, breast oncology has evolved in numerous ways. It's become more personalized. There have been huge changes in the treatment landscape. Treatment options are expanding, and this is exciting for us as providers and our patients. We now have more targeted agents, which have been shown to improve median progression-free survival. And I believe, as a field, we're increasingly recognizing that tumor biology is very important.

There are, of course, various subtypes within breast cancer, and these biologies behave in different ways. We have new, exciting data coming out about various drugs that are contributing to our patients’ life spans in a meaningful way.

Now we're at the point of determining how to best use these therapies, [including those] under development. The question is how we can give these drugs in a smart way, not just to prolong life, but to give patients a quality of life, which I believe is critical.

What are the most exciting advancements happening in breast cancer, in your opinion?

I think there are several areas that are really exciting and quite important to our field. In the space of [estrogen receptor (ER)]–positive breast cancer, [we are] utilizing targeted therapies. There are new classes of drugs that help us overcome resistance. We know, for example, that CDK4/6 inhibitors in the first-line metastatic setting have been shown to prolong overall survival in our patients, but further identifying key resistance mechanisms that then drive resistance to CDK4/6 inhibitors is key. There are a lot of novel agents [being developed]. These are selective estrogen receptor degraders, or SERDs; selective estrogen receptor modulators, or SERMs; and proteolysis degradation drugs, such as PROTACs.

In the HER2[-positive] space, we have antibody-drug conjugates and novel HER2-targeting agents.

In the area of triple-negative breast cancer, we are utilizing immunotherapies and vaccines and further understanding how we can hone tumor-infiltrating lymphocytes in the tumor microenvironment.

I would also say that, throughout the breadth of breast cancer, utilization of circulating tumor DNA and other novel technologies [has] helped us learn about tumor biology. At this point, we're trying to integrate information on, for example, a single gene variant, allele fractions, polyclonality, and various other alterations to better understand tumor biology and target tumor growth in a smarter and more sophisticated way.

The last thing that I find incredibly exciting in breast cancer and important is rightsizing our therapies, tailoring treatments to each individual patient to reduce toxicities and improve outcomes, along with survivorship and supportive care.

What are the biggest unmet needs that still exist in the space?

We always have room to grow and room to continue learning. In my opinion, some of the biggest unmet needs would be ensuring that all patients globally have access to the agents that are newly approved. It's also important to figure out how we sequence these therapies and utilize, for example, molecular biomarkers to guide how we use these therapies. I think it's also important for us to understand the interplay of various cross-resistance mechanisms beyond ESR1 mutations and how we can overcome this resistance. And lastly, [we need to learn] how to best manage the toxicities of these novel drugs to enhance the quality of life for our patients who are on these drugs for prolonged periods.

This interview has been lightly edited for space and clarity.

REFERENCE:

1. Sarah Cannon Research Institute expands leadership team with the appointment of Sarah Premji, MD, as assistant director of breast cancer research. News release. Sarah Cannon Research Institute. August 18, 2025. Accessed October 1, 2025. https://tinyurl.com/rwhvvvme