Being one of the largest scientific conferences devoted to a single tumor entity, the San Antonio Breast Cancer Symposium (SABCS) time and again brings together experts from all over the world to discuss the newest data in the field. As always, the 41th SACBS was characterized by a stimulating exchange of arguments and ideas, ensuring further advances in a disease that—despite great progress having been made—is still a life-threatening diagnosis for thousands of patients worldwide. In this issue of MEMO, the most important data in several fields of breast cancer research, including local and systemic treatment, are summarized [1,2,3].

Interesting studies concerning local therapy underlined the importance of shared decision-making when deciding about the mode of surgery and added new information to the discussion of whether or not to recommend axillary dissection (versus radiotherapy only) and whole breast irradiation (versus partial breast irradiation).

As for systemic therapy, data from the KATHERINE trial were practice-changing for patients with HER2-positive disease who have not achieved a pathologic complete remission after neoadjuvant chemo-immunotherapy. Further news pertained to previously published phase III trials: These included the biomarker analysis of IMpassion 130, trying to refine the ideal target population of immunotherapy in triple-negative disease, or several subgroup analyses of SOLAR‑1, the first positive phase III trial testing an α‑specific PI3K inhibitor. The quality of life analysis of TAILORx, evaluating Oncotype DX as a decision tool for chemotherapy, also contributed important information on the differential effects of chemotherapy by age.

In addition to the PI3 kinase inhibitors, promising new therapeutic options under investigation in hormone receptor-positive patients are pembrolizumab combined with abemaciclib, and venetoclax combined with endocrine therapy for patients with BCL-2-overexpressing tumors. Several large meta-analyses, on the other hand, proved the value of improving the rate of pathologic complete remission, or underlined the importance of age (as a surrogate marker for competing causes of mortality) when evaluating the absolute benefit of chemotherapy. The prognostic (but not predictive) value of bone marrow tumor cells was confirmed in the large PADDY study, including more than 10,000 patients.

In summary, the publication of the KATHERINE study at the 41th SABCS changed clinical practice for patients with HER2-positive breast cancer. Apart from this study, several interesting subgroup and biomarker analyses of previously published trials and, in particular, a plethora of smaller studies investigating interesting treatment combinations will hopefully lead the way to further advances in the years to come.