1
|
Tokunaga E, Miyoshi Y, Dozono K, Kawaguchi T, Toi M. Association of Neutrophil-to-Lymphocyte Ratio and Absolute Lymphocyte Count With Clinical Outcomes in Advanced Breast Cancer in the MONARCH 2 Trial. Oncologist 2024; 29:e319-e329. [PMID: 37971418 PMCID: PMC10911923 DOI: 10.1093/oncolo/oyad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Established prognostic factors for treatment response to cyclin-dependent kinases 4 and 6 inhibitors are currently lacking. We aimed to investigate the relationship of pretreatment neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) to abemaciclib outcomes. PATIENTS AND METHODS This was a post hoc analysis of data from MONARCH 2, a phase III study of abemaciclib or placebo plus fulvestrant in hormone-receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer that progressed on endocrine therapy. Patients were divided into high and low categories based on baseline NLR (cutoff: 2.5) and ALC (cutoff: 1.5 × 109/L). The association of baseline NLR and ALC with progression-free survival (PFS) and overall survival (OS) was explored using Cox models and Kaplan-Meier estimates. Tumor response and safety were also examined. RESULTS NLR and ALC data were available for 645 patients (abemaciclib: N = 426; placebo: N = 219). Low-baseline NLR or high-baseline ALC was consistently associated with positive PFS and OS trends; low-baseline NLR subgroups also showed trends for better response. The abemaciclib treatment effect against placebo was observed regardless of baseline NLR or ALC. Univariate analyses showed baseline NLR and ALC were prognostic of PFS and OS. Baseline NLR remained significant in the multivariate model (P < .0001). No unexpected differences in safety were observed by baseline NLR or ALC. CONCLUSION Baseline NLR was independently prognostic of PFS and OS. Low-baseline NLR was associated with numerically better efficacy outcomes, but the benefit of adding abemaciclib to fulvestrant was similar irrespective of baseline NLR status.
Collapse
Affiliation(s)
- Eriko Tokunaga
- Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yasuo Miyoshi
- Department of Surgery, Division of Breast and Endocrine Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Koji Dozono
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Tsutomu Kawaguchi
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Masakazu Toi
- Director, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| |
Collapse
|
2
|
Wang W, Lei W, Fang Z, Jiang R, Wang X. Efficacy, safety, and predictive model of Palbociclib in the treatment of HR-positive and HER2-negative metastatic breast cancer. BMC Cancer 2024; 24:1. [PMID: 38166784 PMCID: PMC10762987 DOI: 10.1186/s12885-023-11764-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE This research designeded to: 1. Analyze the efficacy and safety of Palbociclib treatment in HR-positive and HER2-negative (HR + /HER2-) metastatic breast cancer(MBC) patients. 2. Establish and validate a nomogram model for predicting the progression-free survival (PFS) rates of 6 months, 12 months, and 18 months in HR + /HER2- MBC patients after receiving Palbociclib plus endocrine therapy (ET). PATIENTS AND METHODS 1. This research retrospectively analyzed the efficacy and safety of Palbociclib combined with ET in 214 patients with HR + /HER2- MBC. 2. A nomogram was designed and constructed with the retrospective clinical data of 214 patients with HR + /HER2- MBC who received Palbociclib plus ET at Zhejiang Cancer Hospital in China from August 2018 to August 2022. Among these patients, 161 were randomly assigned to the training cohort, while 53 to the validation cohort. The predictive accuracy of the nomogram was assessed through the analysis the area under the receiver operating characteristic(ROC) curve, calibration curve, and decision curve analysis(DCA). RESULTS 1. Median PFS was 7.17 months (95% CI: 7.61-10.05 months), with an objective response rate (ORR) of 2.80% and a disease control rate (DCR) of 34.58%. The most prevalent grade 3-4 adverse event was neutropenia (38.79%). 2. Multiple variable analysis of the training set revealed that age < 60 years old, PR < 20%, Ki-67 ≥ 20%, luminal B molecular subtype, primary resistance to ET, receipt of late-stage chemotherapy, and presence of liver metastasis or ≥ 2 visceral metastases were independent prognostic factors associated with poor PFS (P < 0.05). Then, the predictive model underwent development and validation utilizing the aforementioned parameters. On the one hand, the area under the ROC curve (AUC) values of the training set at 6 months, 12 months, and 18 months were 0.771, 0.783, and 0.790, respectively, indicating a strong predictive ability of the developed model. On the other hand, the AUC of the validation set at 6 months, 12 months, and 18 months were 0.720, 0.766, and 0.754, respectively, suggesting the favorable discriminatory ability of the model. The calibration curves also exhibited a good fit with the ideal curves, and the DCA demonstrated the clinical applicability of the model. The nomogram's different scores could distinguish PFS. CONCLUSION This retrospective study demonstrates the efficacy of Palbociclib in Chinese breast cancer patients. Moreover, the clinical parameters showed a significant association with the prognosis of HR + /HER2- MBC, and the prognostic models constructed based on these variables also displayed robust predictive power, which could offer more intuitive and convenient references for clinical doctors to formulate follow-up treatment plans.
Collapse
Affiliation(s)
- Wei Wang
- Department of Medical Oncology (Breast Cancer), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshandong Road, Gongshu District, Hangzhou, 310022, Zhejiang, China
- Postgraduate Training Base Alliance of Wenzhou Medical University(Zhejiang Cancer Hospital), Wenzhou Medical University, 270 Xueyuanxi Road, Lucheng District, Wenzhou, 325027, Zhejiang, China
| | - Wenqian Lei
- Department of Clinical Medicine, Medical College of Nanchang University, 461 Bayi Avenue, Donghu District, Nanchang, 330006, Jiangxi, China
| | - Ziru Fang
- Department of Medical Oncology (Breast Cancer), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshandong Road, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Ruiyuan Jiang
- Department of Medical Oncology (Breast Cancer), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshandong Road, Gongshu District, Hangzhou, 310022, Zhejiang, China
| | - Xiaojia Wang
- Department of Medical Oncology (Breast Cancer), Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 1 Banshandong Road, Gongshu District, Hangzhou, 310022, Zhejiang, China.
- Postgraduate Training Base Alliance of Wenzhou Medical University(Zhejiang Cancer Hospital), Wenzhou Medical University, 270 Xueyuanxi Road, Lucheng District, Wenzhou, 325027, Zhejiang, China.
| |
Collapse
|
3
|
Takahashi M, Osako T, Yasojima H, Inoue K, Kawashima M, Maeda H, Ichikawa A, Muramatsu Y, Masuda N. Overall survival in Japanese patients with ER+/HER2- advanced breast cancer treated with first-line palbociclib plus letrozole. Breast Cancer 2024; 31:53-62. [PMID: 37882974 PMCID: PMC10764519 DOI: 10.1007/s12282-023-01511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND An open-label, single-arm, Japanese phase 2 study (J-Ph2) investigated the efficacy and safety of first-line (1L) palbociclib (PAL) + letrozole (LET) in postmenopausal Japanese women with ER+/HER2- advanced breast cancer (ABC). In the final analysis, median progression-free survival was 35.7 months (95% CI 21.7-46.7); but overall survival (OS) data were immature. Here, we report the findings from a follow-up study of J-Ph2 (NCT04735367) evaluating OS and subsequent therapy in these Japanese women. METHODS Patients (N = 42) who participated in J-Ph2 were enrolled in the OS follow-up study. The primary endpoint was OS and secondary endpoints included type and duration of subsequent therapy. RESULTS Patients were a median age of 62.5 years; 48% had visceral metastases. At a median follow-up of 89.7 months, the median OS was 85.4 months (95% CI 64.3-not estimable). Median OS was longer in patients with nonvisceral versus visceral metastases (not reached vs 67.3 months), or with treatment-free interval > 12 months versus ≤ 12 months (85.4 vs 45.4 months), or with treatment duration ≥ 24 months versus < 24 months (not reached vs 47.5 months). Of patients who received a first subsequent therapy (81%), most (67%) continued endocrine-based therapy, while 7% received chemotherapy. The median duration of the first subsequent therapy was 8.3 months (95% CI 3.9-12.2), and the median chemotherapy-free survival was 69.1 months (95% CI 24.2-85.4). CONCLUSIONS In this population of Japanese women with ER+/HER2- ABC, median OS was over 7 years with 1L PAL + LET, supporting the use of 1L PAL + endocrine therapy. TRIAL NUMBER NCT04735367.
Collapse
Affiliation(s)
| | - Tomofumi Osako
- Breast Center, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Hiroyuki Yasojima
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kenichi Inoue
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Maeda
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | | | | | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| |
Collapse
|
4
|
Yang J, Zhao B, Ling X, Li D, Zhao J, Lv Y, Wang G, Liu X, Li N, Yang J. Palbociclib plus endocrine therapy in hormone receptor-positive and HER2 negative metastatic breast cancer: a multicenter real-world study in the northwest of China. BMC Cancer 2023; 23:103. [PMID: 36717797 PMCID: PMC9885675 DOI: 10.1186/s12885-023-10568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Real-world data of Palbociclib are insufficient in China. This study aimed to investigate the treatment pattern and real-world outcomes in hormone receptor positive and human epidermal growth factor 2 receptor negative (HR+/HER2-) metastatic breast cancer (MBC) patients treated with Palbociclib in the northwest of China. METHODS HR+/HER2- MBC patients who received Palbociclib in 8 centers from July 2017 to September 2019 were retrospectively included in this study. Real-world objective response rate (ORR), progression-free survival (PFS) and safety profiles were analyzed. The survival curves were plotted by the Kaplan-Meier method to analyze PFS, which was verified by the log-rank test. RESULTS In total, 211 women were eligible for the analysis. A total of 85 patients (40.3%), 78 (37.0%), and 48 (22.7%) received Palbociclib in the first-, second-, third- or later-line setting, respectively. 46 patients achieved partial response and 145 patients experienced stable disease, with an ORR of 21.8% and a disease control rate of 90.5%. Following a median follow-up period of 14.2 months, the median PFS was 12.2 months (95% confidence interval, 10.1-14.3 m), and the median overall survival was not reached. Early Palbociclib initiation, sensitivity or acquired resistance to endocrine therapy, estrogen receptor and progesterone receptor double positivity, less than 3 metastatic sites, without visceral metastasis, bone metastasis only, without prior chemotherapy or endocrine therapy were associated with a prolonged PFS in MBC (All P < 0.05). The most common grade 3 or 4 adverse events (AE) was neutropenia (36.5%), and the most common nonhematologic AE was fatigue (10.9%). No patient experienced AE leading to treatment discontinuation. CONCLUSION Palbociclib plus endocrine therapy exhibited favorable effectiveness and manageable toxicities in the real-world setting, supporting their use in Chinese patients with HR+/HER2 - MBC.
Collapse
Affiliation(s)
- Jiao Yang
- grid.452438.c0000 0004 1760 8119Departments of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, 710061 Xi’an, Shaanxi P.R. China
| | - Bing Zhao
- grid.13394.3c0000 0004 1799 3993Breast Internal Medicine Department, The 3rd Affiliated Teaching Hospital of XinJiang Medical University (Affiliated Tumor Hospital), No. 789 Suzhou East Road, Xinshi District, 830011 Urumqi, Xinjiang China
| | - Xiaoling Ling
- grid.412643.60000 0004 1757 2902Department of Oncology, The First Hospital of Lanzhou University, Lanzhou University, 730000 Lanzhou, Gansu China
| | - Donghui Li
- grid.440288.20000 0004 1758 0451Department of Medical Oncology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi China
| | - Jiuda Zhao
- grid.262246.60000 0004 1765 430XBreast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Yonggang Lv
- grid.412262.10000 0004 1761 5538Department of Thyroid Breast Surgery, the Affiliated Hospital of Northwest University, Xi’an No.3 Hospital, Xi’an, Shaanxi China
| | - Guangxi Wang
- Department of Medical Oncology, Shaanxi Provincial Tumor Hospital, Xi’an, China
| | - Xinlan Liu
- grid.413385.80000 0004 1799 1445Department of Oncology, General Hospital of Ningxia Medical University, 750004 Yinchuan, Ningxia China
| | - Nanlin Li
- grid.233520.50000 0004 1761 4404Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, 710032 Xi’an, China
| | - Jin Yang
- grid.452438.c0000 0004 1760 8119Departments of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, 710061 Xi’an, Shaanxi P.R. China
| |
Collapse
|
5
|
Wang W, Wu J, Chen K, Wang X, Shao X. Prognostic Parameters of Palbociclib in HR+/HER2- Advanced Breast Cancer: A Narrative Review. Technol Cancer Res Treat 2023; 22:15330338231173504. [PMID: 37186799 DOI: 10.1177/15330338231173504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Recent studies have demonstrated that the combination of Cyclin-Dependent Kinase 4/6 Inhibitor (CDK4/6i) and endocrine therapy (ET) is more effective than ET alone and significantly improves progression-free survival (PFS) and overall survival (OS) in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor-2 negative (HER2-) breast cancer (BC). Palbociclib is the first CDK4/6i approved for use, and its clinical advantages have been shown. However, 30% of patients will continue to develop secondary drug resistance. Therefore, exploring the parameters that can predict the efficacy of Palbociclib and developing a clinical prediction model is essential for evaluating the prognosis of patients.
Collapse
Affiliation(s)
- Wei Wang
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiayi Wu
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
- Department of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Keyu Chen
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
- Department of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Xiaojia Wang
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Xiying Shao
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| |
Collapse
|
6
|
Al‑Foheidi M, Albeshri A, Moamenkahan S, Abdullah A, Abualola M, Alharbi M, Refa A, Bayer A, Shaheen A, Aga S, Khan M, Al‑Mansour M, Ibrahim E. Combination of palbociclib with adjuvant endocrine therapy for treatment of hormone receptor‑positive and human epidermal growth factor receptor 2‑negative metastatic breast cancer: An experience at two cancer centers in Saudi Arabia. Mol Clin Oncol 2022; 17:119. [PMID: 35747598 PMCID: PMC9204325 DOI: 10.3892/mco.2022.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Meteb Al‑Foheidi
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Asem Albeshri
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Safwan Moamenkahan
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Abdulmajid Abdullah
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Muhannad Abualola
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Muath Alharbi
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ahmed Refa
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ali Bayer
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ahmed Shaheen
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Syed Aga
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Muhammad Khan
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Mubarak Al‑Mansour
- Princess Noorah Oncology Center, National Guard Health Affairs, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ezzeldin Ibrahim
- Oncology Center, International Medical Center, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah 21423, Kingdom of Saudi Arabia
| |
Collapse
|
7
|
Shikanai A, Horimoto Y, Ishizuka Y, Uomori T, Nakai K, Arakawa A, Saito M. Clinicopathological Features Related to the Efficacy of CDK4/6 Inhibitor-Based Treatments in Metastatic Breast Cancer. BREAST CANCER: BASIC AND CLINICAL RESEARCH 2022; 16:11782234211065148. [PMID: 35002243 PMCID: PMC8738870 DOI: 10.1177/11782234211065148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Resistance to endocrine therapy has been a major obstacle in the management of hormone receptor (HR)-positive metastatic breast cancer (MBC). Meanwhile, a number of treatments are available to such patients, and physicians often encounter difficulties in choosing the most appropriate treatments for individual patients. The combination of CDK 4/6 inhibitors (CDKi) and endocrine therapy has now become a standard treatment for HR-positive and human epidermal growth factor receptor 2 (HER2)-negative MBC. However, no predictive markers for CDKi-based treatments have been established. Considering their side effects and the financial burden on patients, identifying such markers is crucial. Methods: Clinicopathological features of 107 patients with HR-positive HER2-negative MBC, who received CDKi-based treatments at our institution were retrospectively investigated. HR status in distant metastatic lesions and immunocompetent cells in peripheral blood were also studied. Results: Progression-free survival (PFS) was significantly shorter in patients whose primary tumour was high grade (P = 0.016) or high neutrophil-to-lymphocyte ratio (NLR) at baseline (P = 0.017). Meanwhile, there were no differences in other factors, such as expression levels of hormone receptors. Patients whose metastatic lesions were of low tumour grade or high Ki67 labelling index had longer PFS, and such trends were more obvious than primary lesions. Conclusion: Our data indicate that tumour grade in primary lesion and NLR are potential predictive factors for CDKi-based treatments. Moreover, pathological assessment of metastatic lesions might also be useful.
Collapse
Affiliation(s)
- Ayana Shikanai
- Department of Breast Oncology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshiya Horimoto
- Department of Breast Oncology, School of Medicine, Juntendo University, Tokyo, Japan.,Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Yumiko Ishizuka
- Department of Breast Oncology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshitaka Uomori
- Department of Breast Oncology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Katsuya Nakai
- Department of Breast Oncology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Mitsue Saito
- Department of Breast Oncology, School of Medicine, Juntendo University, Tokyo, Japan
| |
Collapse
|
8
|
Masuda N, Kosaka N, Iwata H, Toi M. Palbociclib as an early-line treatment for Japanese patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer: a review of clinical trial and real-world data. Int J Clin Oncol 2021; 26:2179-2193. [PMID: 34698970 PMCID: PMC8580935 DOI: 10.1007/s10147-021-02013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/19/2021] [Indexed: 12/09/2022]
Abstract
Breast cancer is the most common type of cancer among women worldwide and in Japan. The majority of breast cancers are hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2‒), and endocrine therapy is an effective therapy for this type of breast cancer. However, recent substantial advances have been made in the management of HR+/HER2‒ advanced breast cancer (ABC) with the advent of targeted therapies, such as cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, resulting in significant improvements in survival outcomes versus endocrine therapy alone. To evaluate the optimal use of palbociclib, a CDK4/6 inhibitor, in HR+/HER2- ABC, this review summarizes clinical trial and real-world data for palbociclib. In addition, current biomarker studies in palbociclib clinical research are reviewed. In Japanese patients, palbociclib was shown to be effective with a manageable safety profile, although differences were observed in the frequency of adverse event and dosing parameters. Current evidence supporting palbociclib as a first-line treatment strategy for patients with HR+/HER2‒ ABC in Asia, and specifically japan, is also discussed.
Collapse
Affiliation(s)
- Norikazu Masuda
- National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuou-ku, Osaka-city, 540-0006, Japan.
| | | | | | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
9
|
Kim JY, Oh JM, Park YH, Ahn JS, Im YH. Which Clinicopathologic Parameters Suggest Primary Resistance to Palbociclib in Combination With Letrozole as the First-Line Treatment for Hormone Receptor-Positive, HER2-Negative Advanced Breast Cancer? Front Oncol 2021; 11:759150. [PMID: 34745997 PMCID: PMC8566811 DOI: 10.3389/fonc.2021.759150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 01/12/2023] Open
Abstract
In this study, we evaluated clinical parameters to predict the primary resistance of palbociclib in combination with endocrine therapy as the first-line treatment in patients with hormone receptor (HR)+, human epidermal growth factor receptor 2 (HER2)- metastatic breast cancer (MBC). We performed a data analysis of patients diagnosed with HR+, HER2-MBC who received palbociclib plus letrozole as the first-line treatment in the metastatic setting from the clinical data warehouse in Samsung Medical Center. In this study, 305 patients were included in the final data analysis. The median follow-up duration was 31 months, and we observed 123 cases of disease progression. The median progression-free survival (PFS) was 28.7 months, and 38 patients (12.5%) had less than a 6-month PFS. The multivariate analysis suggested that primary resistance to adjuvant endocrine therapy (ET) (hazard ratio: 1.91), presence of liver metastasis (hazard ratio: 2.17), initial elevation of serum CA-15-3 (hazard ratio: 1.99), weak positivity of estrogen receptor (ER) (hazard ratio: 2.28), Ki-67 3+ or 4+ (hazard ratios: 2.58 and 10.28), and presence of mutation (hazard ratio: 9.59) were associated with a short PFS duration. A further prediction model was developed with data from 256 patients and 33 cases of disease progression in 6 months. This model included five factors-primary resistance to adjuvant ET (odds ratio, OR: 1.14), liver metastasis (OR: 1.56), initial CA-15-3 elevation (OR: 1.51), weak ER expression (OR: 2.22), and BRCA2 mutation (OR: 2.85)-and the area under the receiver operating characteristic curve was 0.842 (95% CI: 0.775, 0.909; p < 0.001). Finally, we divided them into four risk groups according to the prediction model with the five risk factors. These four groups had different PFS (p < 0.001) and primary resistance of palbociclib with letrozole [OR of group 2 vs. group 1 (ref): 2.18 (p = 0.002), OR of group 3: 3.91 (p < 0.001), and OR of group 4: 4.25 (p < 0.001)]. We developed a prediction model of primary resistance to palbociclib with letrozole as the first-line treatment for HR+, HER2-MBC. Our prediction model might be helpful for considering the first-line treatment strategies. Further well-designed clinical trials would be warranted to validate our prediction model.
Collapse
Affiliation(s)
- Ji-Yeon Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Min Oh
- Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Hyuck Im
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|