BREAST CANCER: Edited by Gottfried E. KonecnyNew treatment options for hormone receptor positive breast cancer in 2023Lüftner, Dianaa,b Author Information aImmanuel Hospital Märkische Schweiz, Buckow bMedical University of Brandenburg Theodor Fontane, Immanuel Campus Rüdersdorf, Rüdersdorf bei Berlin, Germany Correspondence to Professor Diana Lüftner, Immanuel Klinik Märkische Schweiz, Lindenstraße 68-70, Buckow 15377, Germany. Tel: +177 3323240; e-mail: [email protected] Current Opinion in Obstetrics and Gynecology 35(1):p 62-66, February 2023. | DOI: 10.1097/GCO.0000000000000834 Buy Metrics Abstract Purpose of review Hormone receptor positive, human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer does respond to chemotherapy but can be addressed with a better therapeutic index by using biologically modified endocrine therapy. The most pronounced recent successes were reached by antibody drug conjugates (ADCs). Recent findings In early HR+/HER2- disease, adjuvant treatment escalations have taken place for high-risk patients using abemaciclib for the HR+ BRCA- subset and olaparib for HR+ BRCA+ patients. In metastatic spread, among all CDK (cyclin-dependent kinase) 4/6 inhibitors used for first-line therapy, only ribociclib improved overall survival in pre and postmenopausal patients. Palbociclib failed to demonstrate overall survival benefits. New options come up with oral selective oestrogen receptor degraders (SERDs) such as elacestrant, which will replace fulvestrant and is clinically important in combination therapies. ADCs, together with new patient categories such as HER2low or HER3+, enlarge the treatment portfolio and challenge the need of supportive care. The antitrophoblast antigen 2 (TROP2) ADC sacituzumab govitecan improves overall survival in heavily pretreated HR+/HER2- patients by 3.2 months. The best improvement of overall survival was shown bý trastuzumab deruxtecan in less pretreated HER2low (HER2 1+ or HER2 2+/no gene amplification) patients with a gained life span of 6 months. Summary Real-world data on the sequence of different ADCs with similar payloads are needed to establish best possible treatment algorithms. All these new agents will find their place after CDK4/6 inhibitor-based endocrine combination therapy. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.