ESMO 2025 and new therapies in breast cancer: does society always benefit?

The ESMO 2025 Congress delivered practice-defining data across breast cancer. Key results included the first overall survival benefit for an adjuvant CDK4/6 inhibitor in high-risk HR+/HER2- early breast cancer and T-DXd established as standard in high-risk HER2+ disease. Novel antibody-drug conjugates redefined first-line therapy for metastatic TNBC. Updated guidelines mandate broader NGS profiling for PALB2, AKT1, and PTEN alterations. A strong emphasis emerged on biomarker-driven de-escalation, strategic sequencing, and proactive endocrine resistance management. However, benefits must be balanced against cost, equity, and the need for academically derived biomarkers. This report summarizes pivotal presentations reshaping clinical decision-making while reflecting on societal impact.