From the San Antonio Breast Cancer Symposium an important acknowledgement of the Michelangelo Foundation’s work and experts: Dr. Luca Gianni, co-founder of Fondazione Michelangelo, Chair of the “Breast Cancer Research Committee Fondazione Michelangelo”, and president of Fondazione Gianni Bonadonna, was invited to share knowledge on the role of neoadjuvant therapy in HER2+ breast cancer; Raza Ali, from the Cancer Research UK Cambridge Institute, discussed the Imaging Mass Cytometry (IMC) technology, a method he developed and applied to data from patients involved in Michelangelo Foundation’s clinical trials. During the educational session entitled ‘Predictive Value of Treatment Response and Residual Disease after Neoadjuvant Therapy’ Dr. Luca Gianni discussed the role of neoadjuvant therapy (i.e. administered before surgery) in HER2+ breast cancer by analyzing data coming from multiple trials in different clinical settings. «The clinical success of neoadjuvant trials in HER2+ early breast cancer went hand-to-hand with translational studies that are identifying markers predicting for pathologic complete response (pCR) and event free survival that are and will be used to fine tuning a more individually tailored approach to treatment, and eventually effective and safe de-escalation strategies», dr. Gianni said. «All current and future treatments will greatly depend on the neoadjuvant approach as a tool for a quick assessment of the clinical value of new therapies. Such approach has so far been used as basis or supporting evidence for regulatory approvals worldwide, based on the concept that pCR can be viewed as surrogate of long-term benefit. The benefits of tumor eradication at individual level continue to support the simple clinical concept that more pCR is better and that regimens leading to it deserve full credit».In the educational session ‘Spatial and Single Cell Characterization of Breast Cancer Progression’ Dr. Raza Ali analyzed the role of mass cytometry imaging (IMC) in breast cancer. This technology has been successfully applied to the study of the spatial organization and heterogeneity of both the tumor and its microenvironment at single cell resolution, as well as to establish correlations between the tumor structure in space and immunotherapy response: «The imaging of prospectively collected longitudinal samples in clinical trials is feasible and cell-cell interactions are key predictors of immunotherapy response; the tumor structure is crucial for this response and identifying it through IMC holds potential for personalizing immuno-oncology», Raza Ali concluded.