HRP-Fusion Model Improves HER2-Positive Breast Cancer Response Prediction; HER2-Targeted Therapy Landscape Expands

Researchers presented the HRP-Fusion model, a multi-regional fusion framework that improved prediction of pathological complete response (pCR) in HER2-positive breast cancer, at ESMO TAT Asia 2026. The model, which combines radiomics with deep-learning features and clinicopathological information, achieved an area under the curve (AUC) of 0.915 in a multicenter training set and maintained high performance in external validation. In parallel discussions, experts highlighted a growing pipeline of antibody-drug conjugates targeting new endometrial cancer targets beyond HER2 and strategies to promote equitable access to HER2-targeted therapies.

The HRP-Fusion model was compared with five other models (Clinical, Intratumoral, Peritumoral, Fusion Radiomics, DL-only) in a retrospective, multicenter study of 422 patients. It achieved an AUC of 0.915 (95% confidence interval 0.877–0.953) in the training set (n=222), significantly outperforming Clinical and DL-only models, with AUCs of 0.873 (external validation set 1, n=108) and 0.895 (external validation set 2, n=92). Intratumoural texture complexity and the tumour–stroma interface were the primary biological drivers of treatment response prediction. Unlike spatial transcriptomics, this 'macroscopic' imaging model is non-invasive, affordable, and requires less bioinformatics expertise. The findings were described as potentially advancing towards a non-invasive marker that, if prospectively validated across multiple centres, could support personalised treatment adaptation, including escalation or de-escalation strategies.

Beyond HER2, interest in endometrial cancer is focusing on a growing pipeline of antibody-drug conjugates directed at additional targets. TROPE2 and other emerging targets are generating enthusiasm, particularly because they may broaden treatment options for patients who do not meet narrower biomarker criteria associated with some currently available therapies. Payloads and toxicity profiles may affect adoption in routine care, with gastrointestinal adverse events, stomatitis, pulmonary concerns, and supportive care requirements all factoring into how clinicians view the next wave of therapies. Efficacy might also differ across levels of target expression and histologic subtypes, reinforcing the need for more refined biomarker strategies.

Ensuring equitable access to novel HER2-targeted therapies requires addressing financial toxicity, logistical barriers, and reliable biomarker testing. Many patients face high out-of-pocket costs or insurance hurdles, making clinician awareness of coverage options, patient assistance programs, and co-pay support essential. Equitable access also depends on the availability of subspecialists to manage therapy-related toxicities, such as timely access to pulmonologists, ophthalmologists, or imaging services. Accurate HER2 testing ensures that patients receive therapies appropriate to their HER2 status, particularly as emerging treatments target HER2-low and ultra-low subtypes. The logistical burden of frequent infusions can limit access, especially for patients in rural or remote areas; subcutaneous formulations are anticipated to reduce travel demands and improve accessibility. Knowledge dissemination for community adoption can be supported through interactive learning formats, such as case discussions and digital 'snackable' content. By combining proactive education, financial and logistical support, and robust professional networks, clinicians can help expand access to HER2-targeted therapies across diverse practice settings, ultimately improving patient outcomes.