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Fiste O, Mavrothalassitis E, Apostolidou K, Trika C, Liontos M, Koutsoukos K, Kaparelou M, Dimitrakakis C, Gavriatopoulou M, Dimopoulos MA, Zagouri F. Cardiovascular complications of ribociclib in breast cancer patients. Crit Rev Oncol Hematol 2024; 196:104296. [PMID: 38395242 DOI: 10.1016/j.critrevonc.2024.104296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors have unprecedentedly advanced hormone-dependent breast cancer treatment paradigm. In the metastatic setting, ribociclib has consistently demonstrated survival benefit in pre-, peri-, and postmenopausal patients, conjugating efficacy with health-related quality of life preservation. Accordingly, the emergence of cardiac and/or vascular adverse events related to this novel targeted agent is gaining significant interest. This narrative review provides an overview of the incidence and spectrum of cardiovascular toxicity, in both clinical trial framework and real-world evidence. The potential pathogenetic mechanism, along with the available diagnostic parameters including biomarkers, and proper management, are also summarized.
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Affiliation(s)
- Oraianthi Fiste
- Oncology Unit, Third Department of Internal Medicine and Laboratory, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens 11527, Greece.
| | | | - Kleoniki Apostolidou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Chrysanthi Trika
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Konstantinos Koutsoukos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Maria Kaparelou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Constantine Dimitrakakis
- First Department of Obstetrics and Gynecology, Alexandra University Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Meletios Athanasios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens 11528, Greece
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Borstnar S, Palacova M, Łacko A, Timcheva C, Gal-Yam EN, Papazisis K, Beniak J, Kudela P, Rubovszky G. Ribociclib plus letrozole in patients with hormone receptor-positive, HER2-negative advanced breast cancer with no prior endocrine therapy: subgroup safety analysis from the phase 3b CompLEEment-1 trial. Radiol Oncol 2022; 56:238-47. [PMID: 35575587 DOI: 10.2478/raon-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The CDK4/6 inhibitor, ribociclib in combination with endocrine therapy significantly improved progression-free survival in the first line setting in post-menopausal patients with HR+/HER2- advanced breast cancer (ABC) in a pivotal phase 3, placebo-controlled trial (MONALEESA-2) and demonstrated superior overall survival in premenopausal patients with HR+/HER2- ABC (MONALEESA-7). The multinational, phase 3b, CompLEEment-1 trial, which assessed the safety and efficacy of ribociclib plus letrozole in a broader population of patients who have not received prior endocrine therapy for advanced disease, is the largest phase 3 clinical trial to date to evaluate the safety and efficacy of a CDK4/6 inhibitor. We report a subanalysis of data from patients (N = 339) enrolled in the central and south European countries of the SERCE (Southern Europe, RUC, Central Europe) cluster of CompLEEment-1. PATIENTS AND METHODS Men and women of any menopausal status with HR+/HER2- ABC received once-daily oral ribociclib 600 mg (3-weeks on/1-week-off), plus letrozole 2.5 mg continuously. Men/premenopausal women also received a GnRH-agonist. The primary outcome was the number of patients with adverse events (AEs) over a timeframe of approximately 36 months. Time-to-progression, overall response rate, and clinical benefit rate were also measured. RESULTS Safety results in the SERCE subgroup were consistent with those in the pivotal clinical trials of ribociclib in combination with endocrine therapy. Treatment-related AEs leading to dose adjustments/interruption occurred in 63.1% of patients but led to treatment discontinuation in only 10.6%. The most common treatment-related AEs of grade ≥ 3 were neutropenia and transaminase elevations. There were no fatal treatment-related events. CONCLUSIONS These findings from the SERCE subgroup support the safety and manageable tolerability of ribociclib in a broad range of patients with HR+/HER2- ABC more representative of patients in real-world clinical practice.
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Kraus AL, Yu-Kite M, Mardekian J, Cotter MJ, Kim S, Decembrino J, Snow T, Carson KR, Motyl Rockland J, Gossai A, Wilner K, Wang DD, Huang Bartlett C, Oharu N, Schnell P, VanArsdale T, Lu DR, Tursi JM. Real-World Data of Palbociclib in Combination With Endocrine Therapy for the Treatment of Metastatic Breast Cancer in Men. Clin Pharmacol Ther 2021; 111:302-309. [PMID: 34668577 DOI: 10.1002/cpt.2454] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/06/2021] [Indexed: 12/27/2022]
Abstract
This report examined the benefits and risks of palbociclib plus endocrine therapy (ET) in men with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). Palbociclib was evaluated using three independent data sources: real-world data from pharmacy and medical claims, a de-identified real-world data source derived from electronic health records (EHRs), and a global safety database. From medical and pharmacy records, 1,139 men with MBC were identified; in the first-line setting, median duration of treatment was longer with palbociclib plus ET (n = 37, 8.5 months, 95% confidence interval (CI), 4.4-13.0) than ET alone (n = 214, 4.3 months, 95% CI, 3.0-5.7) and specifically, was longer with palbociclib plus letrozole (n = 26, 9.4 months, 95% CI, 4.4-14.0) than letrozole alone (n = 63, 3.0 months, 95% CI, 1.8-4.8). In the EHR-derived database, 59 men received treatment for MBC; real-world response across all lines of therapy in the metastatic setting was reported in 4 of 12 patients (33.3%) in the palbociclib plus ET group vs. 1 of 8 (12.5%) patients in the ET group. Review of the global safety database did not identify any new safety signals in palbociclib-treated men. Real-world data indicated that men with MBC benefit from palbociclib plus ET, with a safety profile consistent with previous observations in women with MBC. Collective data on palbociclib in women and men in this report, including clinical trial data, real-world data, and a well-established risk/benefit profile, led to US approval of an expansion of the palbociclib indication to include men with MBC.
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Affiliation(s)
| | | | | | | | - Sindy Kim
- Pfizer Inc, San Diego, California, USA
| | | | - Tamara Snow
- Flatiron Health, Inc, New York, New York, USA
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Bellet M, Ahmad F, Villanueva R, Valdivia C, Palomino-Doza J, Ruiz A, Gonzàlez X, Adrover E, Azaro A, Valls-Margarit M, Parra JL, Aguilar J, Vidal M, Martín A, Gavilá J, Escrivá-de-Romaní S, Perelló A, Hernando C, Lahuerta A, Zamora P, Reyes V, Alcalde M, Masanas H, Céliz P, Ruíz I, Gil M, Seguí MÀ, de la Peña L. Palbociclib and ribociclib in breast cancer: consensus workshop on the management of concomitant medication. Ther Adv Med Oncol 2019; 11:1758835919833867. [PMID: 31205497 PMCID: PMC6535716 DOI: 10.1177/1758835919833867] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
Drug–drug interactions are of significant concern in clinical practice in oncology, particularly in patients receiving Cyclin-dependent kinase (CDK) 4/6 inhibitors, which are typically exposed to long-term regimens. This article presents the highlights from the ‘First Workshop on Pharmacology and Management of CDK4/6 Inhibitors: Consensus about Concomitant Medications’. The article is structured into two modules. The educational module includes background information regarding drug metabolism, corrected QT (QTc) interval abnormalities, management of psychotropic drugs and a comprehensive review of selected adverse effects of palbociclib and ribociclib. The collaborative module presents the conclusions of the five working groups, each of which comprised five experts from different fields. From these conclusions positive lists of drugs for treating common comorbid conditions that can be safely administered concomitantly with palbociclib and/or ribociclib were developed.
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Affiliation(s)
- Meritxell Bellet
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - Faten Ahmad
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rafael Villanueva
- Institut Català d'Oncologia, Hospital Moisès Broggi, Barcelona, Spain
| | | | - Julián Palomino-Doza
- Hereditary Cardiopathies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ada Ruiz
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, and Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Xavier Gonzàlez
- Instituto Oncológico Dr Rosell, Hospital General De Catalunya, SOLTI, Barcelona, Spain
| | - Encarna Adrover
- Servicio de Oncología Médica, Complejo Hospital Universitario Albacete, Albacete, Spain
| | - Analía Azaro
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology. Barcelona, Spain
| | | | | | - Juan Aguilar
- Medical Oncology Department and Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Vidal
- Hospital Clínic Barcelona and Translational Genomics and Targeted Therapeutics in Solid Tumors Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Anastasi Martín
- Unitat de Cures Palliatives, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Joaquín Gavilá
- Fundacion Instituto Valenciano De Oncologia, Valencia, Spain
| | | | - Antonia Perelló
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Cristina Hernando
- Hospital Clínico Universitario de Valencia, INCLIVA Institut d'Investigació Sanitària and Centro de Investigación Biomédica en Red Cáncer, Valencia, Spain
| | | | - Pilar Zamora
- Servicio de Oncologia Médica, Hospital Universitario La Paz, Madrid, Spain
| | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Alcalde
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Isabel Ruíz
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miguel Gil
- Institut Català d'Oncologia, IDIBELL Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet, Barcelona, Spain
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