Molecular Tumor Board Insights from the 2026 Miami Breast Cancer Conference

At the 2026 Miami Breast Cancer Conference, Kevin Kalinsky, MD, MS, participated in a molecular tumor board session that brought together a multidisciplinary panel including medical oncologists, surgeons, and radiation oncologists to discuss four patient cases. Dr Kalinsky highlighted two cases in particular.

The first centered on the "SERENA-6 type" patient—those with first-line hormone receptor-positive, HER2-negative metastatic breast cancer on an aromatase inhibitor plus a CDK4/6 inhibitor. The discussion focused on whether there is clinical utility in testing for ESR1 mutations in patients without radiographic progression, and whether switching to camizestrant (an oral SERD) combined with continued CDK4/6 inhibition offers benefit over maintaining the current regimen. The board also addressed somatic PALB2 and ERBB2 mutations, with the broader theme being how genomic findings should inform treatment decisions in metastatic disease.

Dr Kalinsky's key takeaway was that this is not a one-size-fits-all field. As the ability to target specific tumor alterations becomes more precise and better tolerated, treatment paradigms continue to evolve. SERENA-6 may represent a paradigm shift for select patients by enabling mutation-driven decision-making.

A notable strength of the multidisciplinary format was the ability to address local therapy questions alongside systemic ones — including which targeted agents can be safely combined with radiation, and how to manage isolated liver metastases using modalities such as SBRT, Y-90, or radiofrequency ablation.

Dr Kalinsky also observed a growing trend among both academic and community oncologists toward broader use of circulating tumor DNA and genomic profiling across tumor types. He emphasized that staying current with this rapidly evolving data is essential for all oncologists, as treatment approaches for mutations like ESR1 and PIK3CA are likely to shift significantly in the coming years.