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Chavarría Piudo N, Blancas I, González Flores E, Henao Carrasco F, López Álvarez P, Morales Pancorbo D, Gámez Casado S, Lomas Garrido MDLC, Rodríguez García JM, Martínez Guisado A, Sánchez Vega A, Ruíz Borrego M. Retrospective registry of patients with locally advanced/metastatic HR +/HER2 - breast cancer treated in clinical practice in Andalusia. Clin Transl Oncol 2024:10.1007/s12094-024-03510-8. [PMID: 38831191 DOI: 10.1007/s12094-024-03510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/26/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Limited data are available regarding the real-world effectiveness and safety of Cyclin Dependent Kinase 4/6 inhibitor (CDK4/6i) (palbociclib/ribociclib) just as a first-line treatment for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR + /HER2‒) metastatic breast cancer (MBC). OBJECTIVE To assess whether clinical or demographic characteristics limit access to first-line CDK4/6i treatment in clinical practice in the Autonomous Community of Andalusia (Spain) between November 2017 and April 2020. In addition, effectiveness will be described in an exploratory analysis. METHODS Physicians from 12 centers participated in selecting demographic and clinical characteristics, treatment, and outcome data from women with HR + /HER2- MBC treated with or without CDK4/6i in addition to hormonal in the first-line setting, in a 3:1 proportion. Kaplan-Meier analysis estimated progression-free rates (PFRs) and survival rates (SRs). RESULTS A total of 212 patients were included, of whom 175 (82.5%) were in the CDK4/6i treatment group and 37 (17.5%) were in the non-CDK4/6i treatment group (control group). Patients in the CDK 4/6i treatment group were younger (p = 0.0011), the biopsies of the metastatic site at the moment of the relapse were most commonly performed (p = 0.0454), and had multiple metastatic sites (p = 0.0025). The clinical benefit rate (CBR) was 82.3% in the CDK4/6i group and 67.8% in the control group. Median time to a progression event or death (PFS) was 20.4 months (95%CI 15.6-28) in the CDK4/6i group and 12.1 months (95%CI 7.9-not reached) in the control group. CONCLUSIONS Younger patients, biopsies of metastatic disease and with multiple metastatic sites were more frequently treated with CDK4/6i in our daily clinical practice.
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Affiliation(s)
- Natalia Chavarría Piudo
- Medical Oncology Service, Instituto de Investigación E Innovación Biomédica de Cádiz (INIBiCA), Institute for Biomedica Research and Innovation, Hospital Universitario de Jerez de La Frontera, Jerez, Cadiz, Spain.
| | - Isabel Blancas
- Medical Oncology Service, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada) and Medicine Department, Hospital Universitario San Cecilio, Granada University, Granada, Spain
| | - Encarna González Flores
- Medical Oncology Service, Hospital Universitario Virgen de Las Nieves, Instituto de Investigación Biosanitaria de Granada (Ibs. GRANADA), Granada, Spain
| | - Fernando Henao Carrasco
- Medical Oncology Service, Hospital Universitario Virgen Macarena, Fundacion Para La Gestión de La Investigacion en Salud de Sevilla (FISEVI), Seville, Spain
| | - Pilar López Álvarez
- Medical Oncology Service, Hospital Universitario Virgen de Valme, Seville, Spain
| | | | - Salvador Gámez Casado
- Medical Oncology Service, Instituto de Investigación E Innovación Biomédica de Cádiz (INIBiCA), Institute for Biomedica Research and Innovation, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | | | | | - Adrián Sánchez Vega
- Medical Oncology Service, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA) [Institute for Biomedica Research and Innovation], Puerto Real, Cádiz, Spain
| | - Manuel Ruíz Borrego
- Medical Oncology Service, Hospital Universitario Virgen del Rocío, Fundacion para la Gestión de la Investigacion en Salud de Sevilla (FISEVI), Sevilla, Spain
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Christiansen EA, Kümler I. Real-world effectiveness of palbociclib in HR+/HER2- metastatic breast cancer: a literature review. Future Sci OA 2024; 10:2340329. [PMID: 38817360 PMCID: PMC11137848 DOI: 10.2144/fsoa-2023-0074] [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: 04/25/2023] [Accepted: 12/01/2023] [Indexed: 06/01/2024] Open
Abstract
Approximately 70% of newly diagnosed breast cancers are of the HR+/HER2- subtype. For the treatment of patients with HR+/HER2- metastatic breast cancer, current guidelines recommend the use of a CDK4/6 inhibitor (palbociclib, ribociclib or abemaciclib) in combination with endocrine therapy. In this review we assess existing literature concerning real-world effectiveness of palbociclib. Survival outcomes in terms of progression-free survival and overall survival are discussed and compared among the included real-world studies and in relation to the phase III PALOMA trials.
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Affiliation(s)
- Emilie Adrian Christiansen
- Faculty of Health & Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Iben Kümler
- Department of Oncology, Herlev & Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls vej 7, 2730 Herlev, Denmark
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Coutinho-Almeida J, Silva AS, Redondo P, Rodrigues PP, Ferreira A. CDK4/6 inhibitors and endocrine therapy in the treatment of metastatic breast cancer: A real-world and propensity score-adjusted comparison. Cancer Treat Res Commun 2024; 40:100818. [PMID: 38761788 DOI: 10.1016/j.ctarc.2024.100818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION/BACKGROUND Hormone Receptor-positive (HR+) and Human Epidermal Growth Factor Receptor 2-negative (HER2-) breast cancer is the most common subtype, predominantly treated with endocrine therapy. The efficacy of CDK4/6 inhibitors combined with endocrine therapy in this context remains to be fully evaluated. MATERIALS (OR PATIENTS) AND METHODS This study compared the effectiveness of CDK4/6 inhibitors (palbociclib and ribociclib) in combination with an aromatase inhibitor or fulvestrant against endocrine therapy alone in patients with HR+/HER2- advanced breast cancer. The main focus was on progression-free survival (PFS) and overall survival (OS). The study involved a population treated exclusively with endocrine therapy for bone involvement, examining median OS and PFS, and adjusting for variables like stage, visceral metastasis, age, and treatment line. RESULTS The study found no significant OS difference between treatments with palbociclib, ribociclib, and endocrine therapy alone. However, ribociclib combined with letrozole significantly improved PFS over letrozole alone. Propensity score weighting indicated a potential 50 % reduction in death risk with ribociclib compared to palbociclib, though this was not confirmed by cox regression. CONCLUSION CDK4/6 inhibitors, particularly ribociclib in combination with letrozole, show promise in improving outcomes for HR+/HER2- breast cancer patients. While palbociclib may not be superior to traditional endocrine therapy, the results underscore the need for further research. These findings could influence future treatment protocols, emphasizing the importance of personalized therapy in this patient group.
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Affiliation(s)
- João Coutinho-Almeida
- CINTESIS - Centre for Health Technologies and Services Research, University of Porto, Porto, Portugal; Health Data Science PhD Program, Faculty of Medicine of the University of Porto, Porto, Portugal; MEDCIDS - Faculty of Medicine of University of Porto, Porto, Portugal.
| | - Ana Sofia Silva
- Portuguese Institute of Oncology at Porto (IPO Porto), Porto, Portugal; Group of Epidemiology, Results, Economy and Management in Oncology, GEREMO (GEREMO) Centro de Investigação, Porto, Portugal
| | - Patrícia Redondo
- Portuguese Institute of Oncology at Porto (IPO Porto), Porto, Portugal; Group of Epidemiology, Results, Economy and Management in Oncology, GEREMO (GEREMO) Centro de Investigação, Porto, Portugal
| | - Pedro Pereira Rodrigues
- CINTESIS - Centre for Health Technologies and Services Research, University of Porto, Porto, Portugal; Health Data Science PhD Program, Faculty of Medicine of the University of Porto, Porto, Portugal; MEDCIDS - Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ana Ferreira
- Portuguese Institute of Oncology at Porto (IPO Porto), Porto, Portugal; IPOP porto, Grupo de Oncologia clínica, centro de investigação, Porto, Portugal
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Brain E, Chen C, Simon S, Pasupuleti V, Pfitzer KV, Gelmon KA. Palbociclib in Older Patients with Advanced/Metastatic Breast Cancer: A Systematic Review. Target Oncol 2024; 19:303-320. [PMID: 38546943 PMCID: PMC11111485 DOI: 10.1007/s11523-024-01046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Palbociclib in combination with endocrine therapy is approved for treatment of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer. In addition to clinical trials, several real-world studies have evaluated the effectiveness of palbociclib. With increased life expectancy in the general population, breast cancer in older women is also expected to increase. OBJECTIVE The aim was to systematically review evidence from both clinical trials and real-world studies for palbociclib treatment outcomes in older patients with HR+/HER2- advanced/metastatic breast cancer (a/mBC). Older patients are often underrepresented in clinical trials, and real-world evidence (RWE) will enrich the analysis of palbociclib outcomes in this subgroup of patients. DESIGN A systematic literature search in PubMed, EMBASE, and Cochrane Library through May 4, 2023, yielded 2355 unique articles. A total of 52 articles (13 and 39 articles reporting results from seven randomized controlled trials [RCTs] and 37 RWE studies, respectively) were included based on study eligibility criteria. RESULTS All RCTs used age cutoffs of ≥ 65 years to define older population (n = 722; 437 received palbociclib); all RWE studies, except one with an age cutoff of > 60 years, had age cutoffs of ≥ 65 years or higher to define older population (n = 9840; 7408 received palbociclib). Overall, in studies that compared efficacy (progression-free survival [seven RCTs, 20 RWE studies], overall survival [four RCTs, 11 RWE studies], tumor response [three RWE studies], and clinical benefit rate [one RCT, two RWE studies]) and safety outcomes (three RCTs, three RWE studies) between older and younger patients, palbociclib showed similar benefits, regardless of age. Results from two RCTs and two RWE studies showed that global quality of life (QoL) was maintained in older patients receiving palbociclib. Overall, palbociclib dose modifications (two RWE studies), dose reductions (one RCT, seven RWE studies), and treatment discontinuation rates (three RCTs, three RWE studies) were higher in older patients compared with younger patients; however, these differences did not appear to adversely impact efficacy outcomes. CONCLUSIONS In this systematic review, data from RCTs showed that palbociclib was effective, well tolerated, and maintained QoL in older patients with HR+/HER2- a/mBC. Palbociclib treatment in older patients in real-world settings was associated with similar clinical benefit as in RCTs. PROSPERO REGISTRATION CRD42023444195.
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Affiliation(s)
- Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Paris, France
| | | | | | | | | | - Karen A Gelmon
- Faculty of Medicine, University of British Columbia, and BC Cancer, 600 W 10th Ave, Vancouver, BC, V5Z 1M9, Canada.
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Liao B, Wang J, Xie Y, Luo H, Min J. LINK-A: unveiling its functional role and clinical significance in human tumors. Front Cell Dev Biol 2024; 12:1354726. [PMID: 38645412 PMCID: PMC11032015 DOI: 10.3389/fcell.2024.1354726] [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: 12/12/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
LINK-A, also recognized as LINC01139, has emerged as a key oncological lncRNA in cancer. LINK-A is upregulated in solid and liquid tumor samples, including breast cancer, ovarian cancer, glioma, non-small-cell lung cancer, and mantle cell lymphoma. Notably, LINK-A is involved in regulating critical cancer-related pathways, such as AKT and HIF1α signaling, and is implicated in a range of oncogenic activities, including cell proliferation, apoptosis, epithelial-mesenchymal transition (EMT), cell invasion and migration, and glycolysis reprogramming. LINK-A's differential expression and its correlation with clinical features enable it to be a promising biomarker for cancer diagnosis, prognosis, and the stratification of tumor progression. Additionally, LINK-A's contribution to the development of resistance to cancer therapies, including AKT inhibitors and immunotherapy, underscores its potential as a therapeutic target. This review provides a comprehensive overview of the available data on LINK-A, focusing on its molecular regulatory pathways and clinical significance. By exploring the multifaceted nature of LINK-A in cancer, the review aims to offer a valuable resource for future research directions, potentially guiding the development of novel therapeutic strategies targeting this lncRNA in cancer treatment.
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Affiliation(s)
- Bing Liao
- Department of Otorhinolaryngology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jialing Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yilin Xie
- Second School of Clinical Medicine, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Hongliang Luo
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jun Min
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
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She Y, Guo Z, Zhai Q, Liu J, Du Q, Zhang Z. CDK4/6 inhibitors in drug-induced liver injury: a pharmacovigilance study of the FAERS database and analysis of the drug-gene interaction network. Front Pharmacol 2024; 15:1378090. [PMID: 38633610 PMCID: PMC11021785 DOI: 10.3389/fphar.2024.1378090] [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: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Objective The aim of this study was to investigate the potential risk of drug-induced liver injury (DILI) caused by the CDK4/6 inhibitors (CDK4/6is abemaciclib, ribociclib, and palbociclib by comprehensively analyzing the FDA Adverse Event Reporting System (FAERS) database. Moreover, potential toxicological mechanisms of CDK4/6is-related liver injury were explored via drug-gene network analysis. Methods In this retrospective observational study, we collected reports of DILI associated with CDK4/6i use from the FAERS dated January 2014 to March 2023. We conducted disproportionality analyses using the reporting odds ratio (ROR) with a 95% confidence interval (CI). Pathway enrichment analysis and drug-gene network analyses were subsequently performed to determine the potential mechanisms underlying CDK4/6i-induced liver injury. Results We found positive signals for DILI with ribociclib (ROR = 2.60) and abemaciclib (ROR = 2.37). DILIs associated with liver-related investigations, signs, and symptoms were confirmed in all three reports of CDK4/6is. Moreover, ascites was identified as an unlisted hepatic adverse effect of palbociclib. We isolated 189 interactive target genes linking CDK4/6 inhibitors to hepatic injury. Several key genes, such as STAT3, HSP90AA1, and EP300, were revealed via protein-protein analysis, emphasizing their central roles within the network. KEGG pathway enrichment of these genes highlighted multiple pathways. Conclusion Our study revealed variations in hepatobiliary toxicity among the different CDK4/6 inhibitors, with ribociclib showing the highest risk of liver injury, followed by abemaciclib, while palbociclib appeared relatively safe. Our findings emphasize the need for cautious use of CDK4/6 inhibitors, and regular liver function monitoring is recommended for long-term CDK4/6 inhibitor use.
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Affiliation(s)
- Youjun She
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zihan Guo
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing Zhai
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiyong Liu
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiong Du
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhongwei Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China
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Read SH, Quignot N, Kapso-Kapnang R, Comerford E, Zheng Y, Gainford C, Sasane M, Vataire AL, Delzongle L, Bidard FC. Treatment patterns of patients with HR+/HER2- metastatic breast cancer receiving CDK4/6 inhibitor-based regimens: a cohort study in the French nationwide healthcare database. Breast Cancer Res Treat 2024; 204:579-588. [PMID: 38206533 PMCID: PMC10959771 DOI: 10.1007/s10549-023-07201-w] [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: 09/13/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To assess real-world treatment patterns in patients diagnosed with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC) who received cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in combination with an aromatase inhibitor (AI) or fulvestrant at first line. METHODS Patient characteristics, treatment history, and outcomes data were extracted from the French 'Système National des Données de Santé' (SNDS) database for patients diagnosed with HR+/HER2- mBC between January 2014 and June 2019 and who received combination therapy with a CDK4/6 inhibitor and endocrine therapy. Kaplan-Meier methodology was used to assess time to next treatment (TTNT) and time to treatment discontinuation (TTTD). RESULTS The cohort comprised 6061 patients including 4032 patients who received CDK4/6 inhibitors + AIs and 2029 patients who received CDK4/6 inhibitors + fulvestrant. Median follow-up was 13.5 months (IQR 9.5-18.1). The median TTTD of first line treatment with CDK4/6 inhibitors + AIs and CDK4/6 inhibitors + fulvestrant was 17.3 months (95% CI 16.8-17.9) and 9.7 months (95% CI 9.0-10.2), respectively. Chemotherapy was the most common second line therapy. Median TTTD of subsequent treatment lines was progressively shorter following first line treatment with CDK4/6 inhibitors + AIs (2nd line: 4.6 months (95% CI 4.4-4.9) and with CDK4/6 inhibitors + fulvestrant (2nd line: 4.7 months (95% CI 4.3-5.1). TTNT was longer than TTTD across lines of therapy. CONCLUSION This real-world analysis confirms the effectiveness of CDK4/6 inhibitor-based regimens in French patients and highlights the frequent use of chemotherapy as second line therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
- Université Versailles Saint-Quentin, Université Paris-Saclay, Saint-Cloud, France
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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.
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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
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Geisler J, Karihtala P, Tuxen M, Valachis A, Holm B. Current treatment landscape of HR+/HER2- advanced breast cancer in the Nordics: a modified Delphi study. Acta Oncol 2023; 62:1680-1688. [PMID: 37713138 DOI: 10.1080/0284186x.2023.2254475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND This Delphi study aimed to assess current perspectives on hormone receptor-positive/human epidermal growth factor receptor 2-negative(HR+/HER2-) advanced breast cancer (aBC) treatment strategies across the Nordics, and to establish where consensus exists across the Nordics on HR+/HER2- aBC treatment. MATERIAL AND METHODS A modified, three-round Delphi method was followed. A steering committee was appointed for study coordination, panellist selection, and questionnaire development. The questionnaires covered relevant topics on HR+/HER2- aBC treatment: treatment patterns in different lines of therapy (first [1L], second [2L], and third [3L]), oligometastatic disease, de novo aBC, brain metastases, age as influential factor, visceral crisis, radiotherapy, diagnostics, and clinical guidelines. Both open and closed-ended questions were included. Consensus was defined as at least 70% agreement. RESULTS In total, 28 experienced BC oncologists participated in the study from all five Nordic countries. Overall, topics reaching consensus included: preferred treatment approach in 1L and 2L therapy, treatment of oligometastatic disease, visceral crisis, brain metastases, and age-related treatment considerations. No consensus was reached for 3L therapy and local treatment for primary tumour in de novo aBC. Endocrine therapy (ET) combined with a cyclin-dependent kinase (CDK)4/6 inhibitor was the treatment of choice for 1L and 2L therapy. Treatment patterns in clinical practice did not always follow recommendations in current Nordic guidelines, as seen in the case of recently approved treatments. DISCUSSION ET in combination with a CDK4/6 inhibitor is the preferred frontline treatment for HR+/HER2- aBC in the Nordics. The observed discrepancy between current guidelines and clinical practice could be due to differences in the reimbursement of novel treatments in the Nordics. Collaborative research efforts are warranted for topics that lack consensus.
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Affiliation(s)
- Jürgen Geisler
- Department of Oncology, University of Oslo and Akershus University Hospital, Akershus, Norway
| | - Peeter Karihtala
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Helsinki, Finland
| | - Malgorzata Tuxen
- Department of Oncology, University of Copenhagen Herlev Hospital, Copenhagen, Denmark
| | - Antonis Valachis
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Barbro Holm
- Department of Oncology, Novartis, Stockholm, Sweden
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Beltrán-Visiedo M, Jiménez-Alduán N, Díez R, Cuenca M, Benedi A, Serrano-Del Valle A, Azaceta G, Palomera L, Peperzak V, Anel A, Naval J, Marzo I. Dinaciclib synergizes with BH3 mimetics targeting BCL-2 and BCL-X L in multiple myeloma cell lines partially dependent on MCL-1 and in plasma cells from patients. Mol Oncol 2023; 17:2507-2525. [PMID: 37704591 DOI: 10.1002/1878-0261.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/01/2023] [Accepted: 09/12/2023] [Indexed: 09/15/2023] Open
Abstract
A better understanding of multiple myeloma (MM) biology has led to the development of novel therapies. However, MM is still an incurable disease and new pharmacological strategies are needed. Dinaciclib, a multiple cyclin-dependent kinase (CDK) inhibitor, which inhibits CDK1, 2, 5 and 9, displays significant antimyeloma activity as found in phase II clinical trials. In this study, we have explored the mechanism of dinaciclib-induced death and evaluated its enhancement by different BH3 mimetics in MM cell lines as well as in plasma cells from MM patients. Our results indicate a synergistic effect of dinaciclib-based combinations with B-cell lymphoma 2 or B-cell lymphoma extra-large inhibitors, especially in MM cell lines with partial dependence on myeloid cell leukemia sequence 1 (MCL-1). Simultaneous treatment with dinaciclib and BH3 mimetics ABT-199 or A-1155463 additionally showed a synergistic effect in plasma cells from MM patients, ex vivo. Altered MM cytogenetics did not affect dinaciclib response ex vivo, alone or in combined treatment, suggesting that these combinations could be a suitable therapeutic option for patients bearing cytogenetic alterations and poor prognosis. This work also opens the possibility to explore cyclin-dependent kinase 9 inhibition as a targeted therapy in MM patients overexpressing or with high dependence on MCL-1.
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Affiliation(s)
| | | | - Rosana Díez
- Apoptosis, Immunity & Cancer Group, IIS Aragón, University of Zaragoza, Spain
- Hematology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marta Cuenca
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Andrea Benedi
- Apoptosis, Immunity & Cancer Group, IIS Aragón, University of Zaragoza, Spain
| | | | - Gemma Azaceta
- Hematology Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- HCU-Lozano Blesa-Hematology Research Group, IIS Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Luis Palomera
- Hematology Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- HCU-Lozano Blesa-Hematology Research Group, IIS Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Victor Peperzak
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Alberto Anel
- Apoptosis, Immunity & Cancer Group, IIS Aragón, University of Zaragoza, Spain
| | - Javier Naval
- Apoptosis, Immunity & Cancer Group, IIS Aragón, University of Zaragoza, Spain
| | - Isabel Marzo
- Apoptosis, Immunity & Cancer Group, IIS Aragón, University of Zaragoza, Spain
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Brufsky A, Liu X, Li B, McRoy L, Chen C, Layman RM, Rugo HS. Palbociclib Combined with an Aromatase Inhibitor in Patients with Breast Cancer with Lung or Liver Metastases in US Clinical Practice. Cancers (Basel) 2023; 15:5268. [PMID: 37958441 PMCID: PMC10649131 DOI: 10.3390/cancers15215268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
A cyclin-dependent kinase 4/6 inhibitor combined with endocrine therapy is the standard of care for patients with hormone receptor-positive/human epidermal growth factor 2-negative (HR+/HER2-) metastatic breast cancer (mBC), but real-world effectiveness data for patients with lung or liver metastases are limited. This retrospective study included data from the US Flatiron Health database of patients with HR+/HER2- mBC and lung or liver metastases treated with first-line palbociclib (PAL) plus an aromatase inhibitor (AI) or an AI alone in routine clinical practice. Overall survival (OS) and real-world progression-free survival (rwPFS) were assessed. A total of 891 patients were included (622 with lung metastasis, 376 with liver metastasis, and 107 with both lung and liver metastasis). After stabilized inverse probability of treatment weighting to balance patient characteristics, PAL + AI versus AI alone was associated with significantly prolonged OS (HR = 0.62; p < 0.001) and rwPFS (HR = 0.55; p < 0.001) in patients with lung metastases and numerically longer OS (HR = 0.73; p = 0.056) and significantly longer rwPFS (HR = 0.57, p < 0.001) for those with liver metastases. Overall, PAL + AI versus AI alone was associated with prolonged OS and rwPFS in routine clinical practice, supporting the use of first-line PAL + AI for patients with HR+/HER2- mBC with lung and/or liver metastases.
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Affiliation(s)
- Adam Brufsky
- UPMC Hillman Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Xianchen Liu
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Benjamin Li
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Lynn McRoy
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Connie Chen
- Pfizer Inc., New York, NY 10001, USA; (X.L.); (B.L.); (L.M.); (C.C.)
| | - Rachel M. Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Hope S. Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA;
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12
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Rugo HS, Liu X, Li B, McRoy L, Chen C, Layman RM, Brufsky A. Real-World Effectiveness of Palbociclib Plus Aromatase Inhibitors in African American Patients With Metastatic Breast Cancer. Oncologist 2023; 28:866-874. [PMID: 37487056 PMCID: PMC10546832 DOI: 10.1093/oncolo/oyad209] [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: 03/06/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Disparities in survival and clinical outcomes between African American and White patients with breast cancer (BC) are well documented, but African American patients have not been well represented in randomized clinical trials of CDK4/6 inhibitors. Real-world studies can provide evidence for effective treatment strategies for underreported patient populations. PATIENTS AND METHODS This retrospective analysis of African American patients with HR+/HER2- metastatic breast cancer (mBC) from the Flatiron Health longitudinal database evaluated treatments for patients with BC in routine clinical practice in the US. Patients initiated first-line therapy with palbociclib plus an aromatase inhibitor (AI) or AI alone between February 2015 and March 2020. Outcomes assessed included overall survival (OS) and real-world progression-free survival (rwPFS) until September 2020. RESULTS Of 270 eligible patients, 127 (median age 64 years) were treated with palbociclib + AI, and 143 (median age 68 years) were treated with an AI. Median follow-up was 24.0 months for palbociclib + AI and 18.2 months for AI-treated patients. Median OS was not reached (NR; 95% CI, 38.2-NR) in the palbociclib + AI group versus 28.2 months (95% CI, 19.2-52.8) in the AI group (adjusted HR, 0.56; 95% CI, 0.36-0.89; P = .013). Median rwPFS was 18.0 months (95% CI, 12.4-26.7) in the palbociclib + AI group and 10.5 months (95% CI, 7.0-13.4) in the AI group (adjusted HR, 0.74; 95% CI, 0.47-1.17; P = .199). CONCLUSION This comparative analysis of palbociclib + AI versus AI alone indicates that palbociclib combined with endocrine therapy in the first line is associated with improved effectiveness for African American patients with HR+/HER2- mBC in real-world settings. TRIAL NUMBER NCT05361655.
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Affiliation(s)
- Hope S Rugo
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | | | | | | | - Rachel M Layman
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam Brufsky
- Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Lee Y, Lee D, Seo I, Chae H, Sim SH, Lee KS, Gwak HS. Risk Factors for Palbociclib-Induced Early Developing Neutropenia in Patients with Hormone Receptor-Positive Metastatic Breast Cancer. Cancers (Basel) 2023; 15:2810. [PMID: 37345147 DOI: 10.3390/cancers15102810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE This study aimed to determine the risk factors for palbociclib-induced grade 4 or grade 3 neutropenia (NP) requiring dose reduction or delayed treatment in patients with HR+/HER2-metastatic breast cancer in the first 3 cycles (early grade 3/4 NP) and whether the early developing grade 3/4 NP affects progression-free survival. METHODS A retrospective study using electronic medical records was conducted on patients who received palbociclib for metastatic breast cancer between January 2018 and August 2022. The early grade 3/4 NP risk factors were evaluated with univariate and multivariable logistic regression analyses. In addition, the Kaplan-Meier method was used to estimate the median progression-free survival (PFS) to analyze the effect of early grade 3/4 NP on treatment. RESULTS Out of the 264 patients included in this study, 173 (65.6%) experienced early grade 3/4 NP. A total of four models were applied for multivariable analysis to identify early grade 3/4 NP-developing factors. Low baseline ANC, WBC, PLT, and BSA were significant risk factors for early grade 3/4 NP; baseline ANC < 3700/mm3, WBC < 6.30 × 109/mm3, PLT < 230 × 109/mm3, and BSA < 1.58 m2 increased the risk by approximately 4.0-fold, 3.7-4.0-fold, 2.1-fold, and 2.0-fold, respectively. Early grade 3/4 NP did not affect PFS (p = 0.710), although patients with early grade 3/4 NP had more frequent dose reductions or treatment delays. CONCLUSIONS Based on the results, low baseline ANC, WBC, PLT, and BSA were associated with early grade 3/4 NP. Patients with risk factors require careful monitoring, and this study is expected to help predict NP, which may appear in early treatment.
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Affiliation(s)
- Yeonhong Lee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea
- Department of Pharmacy, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Dayae Lee
- Department of Pharmacy, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Inyoung Seo
- Department of Pharmacy, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Heejung Chae
- Center for Breast Cancer, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Sung Hoon Sim
- Center for Breast Cancer, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang-si 10408, Republic of Korea
| | - Hye Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea
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14
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Kahraman S, Erul E, Seyyar M, Gumusay O, Bayram E, Demirel BC, Acar O, Aksoy S, Baytemur NK, Sahin E, Cabuk D, Basaran G, Paydas S, Yaren A, Guven DC, Erdogan AP, Demirci U, Yasar A, Bayoglu İV, Hizal M, Gulbagci B, Paksoy N, Davarci SE, Yilmaz F, Dogan O, Orhan SO, Kayikcioglu E, Aytac A, Keskinkilic M, Mocan EE, Unal OU, Aydin E, Yucel H, Isik D, Eren O, Uluc BO, Ozcelik M, Hacibekiroglu I, Aydiner A, Demir H, Oksuzoglu B, Cilbir E, Cubukcu E, Cetin B, Oktay E, Erol C, Okutur SK, Yildirim N, Alkan A, Selcukbiricik F, Aksoy A, Karakas Y, Ozkanli G, Duman BB, Aydin D, Dulgar O, Er MM, Teker F, Yavuzsen T, Aykan MB, Inal A, Iriagac Y, Kalkan NO, Keser M, Sakalar T, Menekse S, Kut E, Bilgin B, Karaoglanoglu M, Sunar V, Ozdemir O, Turhal NS, Karadurmus N, Yalcin B, Nahit Sendur MA. Treatment efficacy of ribociclib or palbociclib plus letrozole in hormone receptor-positive/HER2-negative metastatic breast cancer. Future Oncol 2023; 19:727-736. [PMID: 37133230 DOI: 10.2217/fon-2022-1287] [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: 05/04/2023] Open
Abstract
Background: Ribociclib, palbociclib and abemaciclib are currently approved CDK4/6 inhibitors along with aromatase inhibitors as the first-line standard-of-care for patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Methods: The authors report retrospective real-life data for 600 patients with estrogen receptor- and/or progesterone receptor-positive and HER2-negative metastatic breast cancer who were treated with ribociclib and palbociclib in combination with letrozole. Results & conclusion: The results demonstrated that the combination of palbociclib or ribociclib with letrozole has similar progression-free survival and overall survival benefit in real life for the patient group with similar clinical features. Specifically, endocrine sensitivity may be a factor to be considered in the treatment preference.
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Affiliation(s)
- Seda Kahraman
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey
| | - Enes Erul
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06590, Turkey
| | - Mustafa Seyyar
- Department of Medical Oncology, Kocaeli University Medical Faculty Hospital, Kocaeli, 41000, Turkey
| | - Ozge Gumusay
- Department of Medical Oncology, Acibadem University, School of Medicine, Istanbul, 34750, Turkey
| | - Ertugrul Bayram
- Department of Medical Oncology, Cukurova University, Adana, 01330, Turkey
| | - Burcin Cakan Demirel
- Department of Medical Oncology, Pamukkale University Hospital, Denizli, 20160, Turkey
| | - Omer Acar
- Department of Medical Oncology, Manisa Celal Bayar University Hospital, Mersin, 45120, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06590, Turkey
| | | | - Elif Sahin
- Department of Medical Oncology, Kocaeli University Medical Faculty Hospital, Kocaeli, 41000, Turkey
| | - Devrim Cabuk
- Department of Medical Oncology, Kocaeli University Medical Faculty Hospital, Kocaeli, 41000, Turkey
| | - Gul Basaran
- Department of Medical Oncology, Acibadem University, School of Medicine, Istanbul, 34750, Turkey
| | - Semra Paydas
- Department of Medical Oncology, Cukurova University, Adana, 01330, Turkey
| | - Arzu Yaren
- Department of Medical Oncology, Pamukkale University Hospital, Denizli, 20160, Turkey
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, 06590, Turkey
| | - Atike Pinar Erdogan
- Department of Medical Oncology, Manisa Celal Bayar University Hospital, Mersin, 45120, Turkey
| | - Umut Demirci
- Department of Medical Oncology, Ankara Memorial Hospital, Ankara, 06520, Turkey
| | - Alper Yasar
- Department of Medical Oncology, Marmara University Pendik Research & Application Hospital, Istanbul, 34899, Turkey
| | - İbrahim Vedat Bayoglu
- Department of Medical Oncology, Marmara University Pendik Research & Application Hospital, Istanbul, 34899, Turkey
| | - Mutlu Hizal
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey
| | - Burcu Gulbagci
- Department of Medical Oncology, Sakarya University School of Medicine, Sakarya, 54187, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul University, Istanbul, 34093, Turkey
| | - Sena Ece Davarci
- Department of Medical Oncology, Afyonkarahisar Health Sciences University, Afyonkarahisar, 03200, Turkey
| | - Funda Yilmaz
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training & Research Hospital, Ankara, 06200, Turkey
| | - Ozlem Dogan
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, 06170, Turkey
| | - Sibel Oyucu Orhan
- Department of Medical Oncology, Uludag University, Bursa, 16059, Turkey
| | - Erkan Kayikcioglu
- Department of Medical Oncology, Suleyman Demirel University, Isparta, 32260, Turkey
| | - Ali Aytac
- Department of Medical Oncology, Aydin Adnan Menderes University Training & Research Hospital, Aydin, 09100, Turkey
| | - Merve Keskinkilic
- Department of Medical Oncology, Dokuz Eylül University Research & Application Hospital, Izmir, 35340, Turkey
| | - Eda Eylemer Mocan
- Department Of Medical Oncology, Ankara University, Ankara, 06080, Turkey
| | - Olcun Umit Unal
- Department of Medical Oncology, Tepecik Training & Research Hospital, Izmir, 35180, Turkey
| | - Esra Aydin
- Department of Medical Oncology, Recep Tayyip Erdoğan University Training & Research Hospital, Rize, 53020, Turkey
| | - Hakan Yucel
- Department of Medical Oncology, Gaziantep University, Gaziantep, 27580, Turkey
| | - Deniz Isik
- Department of Medical Oncology, Kocaeli Medical Park Hospital, Kocaeli, 41140, Turkey
| | - Onder Eren
- Department of Medical Oncology, Selcuk University Medical Faculty Hospital, Konya, 42250, Turkey
| | - Basak Oyan Uluc
- Department of Medical Oncology, Acibadem University, School of Medicine, Istanbul, 34750, Turkey
| | - Melike Ozcelik
- Department of Medical Oncology, Umraniye Training & Research Hospital, Istanbul, 34764, Turkey
| | - Ilhan Hacibekiroglu
- Department of Medical Oncology, Sakarya University School of Medicine, Sakarya, 54187, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University, Istanbul, 34093, Turkey
| | - Hacer Demir
- Department of Medical Oncology, Afyonkarahisar Health Sciences University, Afyonkarahisar, 03200, Turkey
| | - Berna Oksuzoglu
- Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training & Research Hospital, Ankara, 06200, Turkey
| | - Ebru Cilbir
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, 06170, Turkey
| | - Erdem Cubukcu
- Department of Medical Oncology, Uludag University, Bursa, 16059, Turkey
| | - Bulent Cetin
- Department of Medical Oncology, Suleyman Demirel University, Isparta, 32260, Turkey
| | - Esin Oktay
- Department of Medical Oncology, Aydin Adnan Menderes University Training & Research Hospital, Aydin, 09100, Turkey
| | - Cihan Erol
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey
| | - Sadi Kerem Okutur
- Department of Medical Oncology, Istanbul Arel University, Bahcelievler Memorial Hospital, Istanbul, 34537, Turkey
| | - Nilgun Yildirim
- Department of Medical Oncology, Firat University Hospital, Elazig, 23200, Turkey
| | - Ali Alkan
- Department of Medical Oncology, Muğla Sıtkı Koçman University Training & Research Hospital, Mugla, 48000, Turkey
| | - Fatih Selcukbiricik
- Department of Medical Oncology, Koç University Hospital, Istanbul, 34010, Turkey
| | - Asude Aksoy
- Department of Medical Oncology, Elazig Fethi Sekin City Hospital, Elazig, 23280, Turkey
| | - Yusuf Karakas
- Department of Medical Oncology, Acıbadem Bodrum Hospital, Mugla, 48420, Turkey
| | - Gulhan Ozkanli
- Department of Medical Oncology, Canakkale Onsekiz Mart University Research & Practice Hospital, Canakkale, 17100, Turkey
| | - Berna Bozkurt Duman
- Department of Medical Oncology, Adana City Training & Research Hospital, Adana, 01230, Turkey
| | - Dincer Aydin
- Department of Medical Oncology, Kocaeli Derince Training & Research Hospital, Kocaeli, 41310, Turkey
| | - Ozgecan Dulgar
- Department of Medical Oncology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, 46050, Turkey
| | - Muhammed Muhiddin Er
- Department of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, 42080, Turkey
| | - Fatih Teker
- Department of Medical Oncology, Gaziantep University, Gaziantep, 27580, Turkey
| | - Tugba Yavuzsen
- Department of Medical Oncology, Dokuz Eylül University Research & Application Hospital, Izmir, 35340, Turkey
| | - Musa Baris Aykan
- Department of Medical Oncology, Gulhane Training & Research Hospital, Ankara, 06010, Turkey
| | - Ali Inal
- Department of Medical Oncology, Mersin City Hospital, Mersin, 96015, Turkey
| | - Yakup Iriagac
- Department of Medical Oncology, Namik Kemal University Health Application & Research Hospital, Tekirdag, 59030, Turkey
| | - Nurhan Onal Kalkan
- Department of Medical Oncology, Van Yüzüncü Yıl University Dursun Odabas Hospital, Van, 65090, Turkey
| | - Murat Keser
- Department of Medical Oncology, Tepecik Training & Research Hospital, Izmir, 35180, Turkey
| | - Teoman Sakalar
- Department of Medical Oncology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, 46050, Turkey
| | - Serkan Menekse
- Department of Medical Oncology, Manisa City Hospital, Manisa, 45040, Turkey
| | - Engin Kut
- Department of Medical Oncology, Manisa City Hospital, Manisa, 45040, Turkey
| | - Burak Bilgin
- Department of Medical Oncology, Konya City Hospital, Konya, 42020, Turkey
| | - Muge Karaoglanoglu
- Department of Medical Oncology, Ordu State Hospital, Ordu, 52200, Turkey
| | - Veli Sunar
- Department of Medical Oncology, Aydin Ataturk State Hospital, Aydin, 09020, Turkey
| | - Ozlem Ozdemir
- Department of Medical Oncology, Izmir Bozyaka Training & Research Hospital, Izmir, 35170, Turkey
| | - Nazim Serdar Turhal
- Department of Medical Oncology, Anadolu Medical Center, Istanbul, 34758, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, Gulhane Training & Research Hospital, Ankara, 06010, Turkey
| | - Bulent Yalcin
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey
| | - Mehmet Ali Nahit Sendur
- Department of Medical Oncology, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, 06800, Turkey
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Zhu W, Zheng M, Xia P, Hong W, Ma G, Shen A. Cost-effectiveness of palbociclib plus fulvestrant as second-line therapy of women with HR+/HER2- advanced breast cancer - A Chinese healthcare system perspective. Front Oncol 2023; 13:1068463. [PMID: 36998437 PMCID: PMC10043429 DOI: 10.3389/fonc.2023.1068463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023] Open
Abstract
AimTo evaluate the cost-effectiveness of palbociclib plus fulvestrant in the second-line treatment of women with hormone receptor-positive and human epidermal growth factor receptor 2-negative advanced breast cancer based on the latest published follow-up data from the perspective of the Chinese healthcare system.MethodsIn view of the PALOMA-3 trial, a Markov model was built for this purpose, which included three health states: progression-free survival (PFS), progressed disease (PD), and death. The cost and health utilities were mainly derived from the published literature. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to verify the robustness of the model.ResultsIn the base case analysis, compared with the placebo plus fulvestrant arm, the palbociclib plus fulvestrant arm yielded an additional 0.65 quality-adjusted life years (QALYs) (2.56 QALYs vs. 1.90 QALYs) with an incremental cost of $36,139.94 ($55,482.06 vs. $19,342.12), resulting an incremental cost-effectiveness ratio (ICER) of $55,224.90/QALY, which was deeply higher than a willingness-to-pay (WTP) threshold of $34,138.28 per QALY in China. The results of one-way sensitivity analysis indicated that the utility of PFS, cost of palbociclib, and cost of neutropenia had a great influence on the ICER.ConclusionsPalbociclib plus fulvestrant is unlikely to be cost-effective in comparison with placebo plus fulvestrant as second-line therapy of women with HR+/HER2- advanced breast cancer.
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Affiliation(s)
- Wentao Zhu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Miaomiao Zheng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Panpan Xia
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Wanglong Hong
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Guoqiang Ma
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Aizong Shen
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
- Department of Pharmacy, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
- *Correspondence: Aizong Shen,
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16
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Rugo HS, Liu X, Li B, McRoy L, Layman RM, Brufsky A. Real-world comparative effectiveness of palbociclib plus letrozole versus letrozole in older patients with metastatic breast cancer. Breast 2023; 69:375-381. [PMID: 37080011 PMCID: PMC10127113 DOI: 10.1016/j.breast.2023.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Palbociclib, the first available cyclin-dependent kinase 4/6 inhibitor, plus endocrine therapy is approved for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (MBC). This study compared real-world effectiveness of palbociclib plus letrozole versus letrozole in older patients with MBC in US clinical practice. METHODS This retrospective analysis included patients from the Flatiron Health longitudinal database. Overall, 796 women with HR+/HER2- MBC aged ≥65 years starting palbociclib plus letrozole or letrozole as first-line therapy between February 2015 and September 2018 were included. Patients were evaluated from treatment start until December 2018, death, or last visit, whichever came first. Real-world progression-free survival (rwPFS), overall survival (OS), and real-world best tumor responses (rwBTR) were endpoints. Stabilized inverse probability treatment weighting (sIPTW) balanced patient characteristics. RESULTS After sIPTW, 450 patients treated with palbociclib plus letrozole and 335 treated with letrozole were included; median age was 74.0 years. Median rwPFS was 22.2 (95% CI, 20.0-30.4) months for palbociclib plus letrozole versus 15.8 (12.9-18.9) months for letrozole (hazard ratio, 0.59 [0.47-0.74]; P<0.001). Median OS was not reached for palbociclib plus letrozole versus 43.4 months (30.0-not estimable) with letrozole (hazard ratio, 0.55 [0.42-0.72]; P<0.001). No interactions between age groups (65-74 and ≥75 years) and treatment groups were observed for rwPFS or OS. Rate of rwBTR was significantly higher for palbociclib plus letrozole (52.4%) versus letrozole (22.1%; odds ratio, 2.0 [1.4-2.7]; P<0.001). CONCLUSION This analysis demonstrates the effectiveness of palbociclib combination therapy as standard-of-care for older patients with HR+/HER2- MBC in the first-line setting.
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17
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Hackert MQN, van Uden-Kraan CF, Agterof MJ, van der Velden AWG, Vriens BEPJ, Janssen JJB, Geenen M, van der Padt-Pruijsten A, van de Garde EMW. Real-world palbociclib effectiveness in patients with metastatic breast cancer: Focus on neutropenia-related treatment modification strategies and clinical outcomes. Cancer Treat Res Commun 2023; 35:100691. [PMID: 36913809 DOI: 10.1016/j.ctarc.2023.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION In addition to clinical trials, real-world data is needed to verify the effectiveness of the CDK 4/6 inhibitor palbociclib. The primary aim was to examine real-world variation in treatment modification strategies for neutropenia and its relation to progression-free survival (PFS). The secondary aim was to assess if there is a gap between real-world and clinical trial outcomes. MATERIALS AND METHODS In this multicenter, retrospective observational cohort study 229 patients were analyzed who started palbociclib and fulvestrant as second- or later-line therapy for HR-positive, HER2-negative metastatic breast cancer in the Santeon hospital group in the Netherlands between September 2016 and December 2019. Data were manually retrieved from patients' electronic medical records. PFS was examined using the Kaplan-Meier method to compare neutropenia-related treatment modification strategies within the first three months after neutropenia grade 3 - 4 occurred, as well as patients' eligibility to have participated in the PALOMA-3 clinical trial or not. RESULTS Even though treatment modification strategies differed from those in PALOMA-3 (dose interruptions: 26 vs 54%, cycle delays: 54 vs 36%, and dose reductions: 39 vs 34%), these did not influence PFS. Patients who were PALOMA-3 ineligible experienced a shorter median PFS than those who were eligible (10.2 vs. 14.1 months; HR 1.52; 95% CI 1.12 - 2.07). An overall longer median PFS was found compared to PALOMA-3 (11.6 vs. 9.5 months; HR 0.70; 95% CI 0.54 - 0.90). CONCLUSION This study suggests no impact of neutropenia-related treatment modifications on PFS and confirms inferior outcomes outside clinical trial eligibility.
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Affiliation(s)
| | | | - Mariette J Agterof
- Department of Internal Medicine, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | | | - Birgit E P J Vriens
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Johan J B Janssen
- Department of Medical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Maud Geenen
- Department of Medical Oncology, OLVG, Amsterdam, The Netherlands
| | | | - Ewoudt M W van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
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18
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Luyendijk M, Blommestein H, Uyl-de Groot C, Siesling S, Jager A. Regulatory Approval, Reimbursement, and Clinical Use of Cyclin-Dependent Kinase 4/6 Inhibitors in Metastatic Breast Cancer in the Netherlands. JAMA Netw Open 2023; 6:e2256170. [PMID: 36795415 PMCID: PMC9936344 DOI: 10.1001/jamanetworkopen.2022.56170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
CONCLUSIONS AND RELEVANCE This study found that CDK4/6 inhibitors rapidly reached many eligible patients with metastatic breast cancer and were adopted gradually over time in the Netherlands. Adoption of innovative medicines may be further optimized, and better transparency of the availability of new medicines during different phases of the postapproval access pathway is needed. DESIGN, SETTING, AND PARTICIPANTS This cohort study reviewed approval and reimbursement decisions of the CDK4/6 inhibitors palbociclib, ribociclib, and abemaciclib and estimated the number of patients with metastatic breast cancer who were eligible for these medicines compared with the actual use in clinical practice. The study used nationwide claims data that were obtained from the Dutch Hospital Data. Claims and early access data for patients with hormone receptor-positive and ERBB2 (formerly HER2)-negative metastatic breast cancer who were treated with CDK4/6 inhibitors from November 1, 2016, to December 31, 2021, were included. IMPORTANCE The number of new cancer medicines that are being approved by regulatory agents is increasing exponentially. Yet little is known about the pace at which these medicines reach eligible patients in daily clinical practice during different phases of the postapproval access pathway. MAIN OUTCOMES AND MEASURES Description of the postapproval access pathway, monthly number of patients who were treated with CDK4/6 inhibitors in clinical practice, and estimated number of patients who were eligible for treatment. Aggregated claims data were used, and patient characteristics and outcomes data were not collected. OBJECTIVE To describe the entire postapproval access pathway of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in the Netherlands, from regulatory approval to reimbursement and to investigate the adoption of these medicines in clinical practice among patients with metastatic breast cancer. RESULTS Three CDK4/6 inhibitors have received European Union-wide regulatory approval for the treatment of HR-positive and ERBB2-negative metastatic breast cancer since November 2016. In the Netherlands, the number of patients who have been treated with these medicines increased to approximately 1847 (based on 1 624 665 claims over the entire study period) from approval to the end of 2021. Reimbursement for these medicines was granted between 9 and 11 months after approval. While awaiting reimbursement decisions, 492 patients received palbociclib, the first approved medicine of this class, via an expanded access program. By the end of the study period, 1616 patients (87%) were treated with palbociclib, whereas 157 patients (7%) received ribociclib, and 74 patients (4%) received abemaciclib. The CKD4/6 inhibitor was combined with an aromatase inhibitor in 708 patients (38%) and with fulvestrant in 1139 patients (62%). The pattern of use over time appeared to be somewhat lower compared with the estimated number of eligible patients (1847 vs 1915 in December 2021), especially in the first 2.5 years after approval.
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Affiliation(s)
- Marianne Luyendijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Hedwig Blommestein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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19
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Kawai M, Takada M, Nakayama T, Masuda N, Shiheido H, Cai Z, Huang YJ, Kawaguchi T, Tanizawa Y. Patient characteristics, treatment patterns, and outcomes of hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer patients prescribed cyclin-dependent kinase 4 and 6 inhibitors: large-scale data analysis using a Japanese claims database. Breast Cancer Res Treat 2023; 197:435-447. [PMID: 36414795 PMCID: PMC9823084 DOI: 10.1007/s10549-022-06816-9] [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: 08/24/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim was to understand real-world cyclin-dependent kinase (CDK) 4 and 6 inhibitor use in Japan. METHODS This retrospective observational study used a Japanese administrative claims database and included patients with presumptive hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (ABC) prescribed CDK4 and 6 inhibitor therapy between December 2017 and March 2021. Patient characteristics, treatment patterns, and selected clinical and safety outcomes were descriptively summarized. Time to discontinuation (TTD) and chemotherapy-free survival (CFS) were examined using Kaplan-Meier estimates. RESULTS The study cohort (N = 6442) was predominantly female (99.4%; median [range] age 64 [26-99] years) with records of metastases (79.6%) within 1 year prior to initiating CDK4 and 6 inhibitor therapy. In total, 4463 (69.3%) and 1979 (30.7%) were prescribed palbociclib and abemaciclib, respectively, as their first CDK4 and 6 inhibitor, most commonly in combination with fulvestrant (n = 3801; 59.0%). Overall, 3756 patients initiated a subsequent anticancer treatment, of whom 748 (19.9%) initiated a different CDK4 and 6 inhibitor in combination with the same or different endocrine therapy. Median TTD (95% confidence interval) was 9.7 (9.3, 10.1) months for the first CDK4 and 6 inhibitor therapy. Median CFS was 26.1 (24.6, 27.8) months. Incidence of clinically relevant diarrhea was higher after abemaciclib initiation (9.8%) than after palbociclib initiation (1.5%). More patients experienced dose reduction with palbociclib (69.3%) than with abemaciclib (53.0%). CONCLUSION The data provide insights into current clinical practices for CDK4 and 6 inhibitor use in Japan that could help establish future treatment strategies for ABC.
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Affiliation(s)
- Masaaki Kawai
- Department of Surgery I, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirokazu Shiheido
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Zhihong Cai
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Yu-Jing Huang
- Global Patient Safety, Eli Lilly and Company, Indianapolis, IN USA
| | - Tsutomu Kawaguchi
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Yoshinori Tanizawa
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
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20
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Low JL, Lim E, Bharwani L, Wong A, Wong K, Ow S, Lim SE, Lee M, Choo J, Lim J, Chan G, Walsh RJ, Muthu V, Ngoi N, Chong W, Tan SH, Lee SC. Real-world outcomes from use of CDK4/6 inhibitors in the management of advanced/metastatic breast cancer in Asia. Ther Adv Med Oncol 2022; 14:17588359221139678. [PMID: 36570409 PMCID: PMC9772978 DOI: 10.1177/17588359221139678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background Oestrogen receptor positive, human epidermal growth factor receptor-2 (HER2) negative breast cancer (BC) is the most frequently diagnosed BC subtype. Combinations of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) with anti-oestrogen therapy have led to improved survival compared with anti-oestrogen therapy alone for advanced/metastatic BC. The evaluation of CDK4/6i in the real-world facilitates treatment planning, insights into the incidence of drug toxicities, dose modifications including dose delays (DDs) and dose reductions (DRs) and improves prognostic accuracy in subgroups, for example geriatric patients, who are under-represented in clinical trials. Methods This multi-centre study analysed retrospective and prospective data from 456 patients treated with CDK4/6i between January 2015 and December 2020. We examined patient characteristics, variation in prescribing practices, efficacy and toxicity outcomes. Results In all, 456 patients were included in this study. The median age was 59 (range: 24-92). In total, 85 (19%) were ⩾70 years old. In all, 122 (27%) and 119 (26%) of patients were treated in the first-line and second-line settings, respectively. In total, 25 (5%), 31 (7%) and 145 (32%) of patients had brain, peritoneum and liver metastasis, respectively, at the time of CDK4/6i initiation. On univariate analysis, heavily pre-treated patients and those with distant metastases, involving the liver, brain or peritoneum, had significantly shorter progression-free survival (PFS) and 24-month overall survival (OS). Elderly patients (⩾70) had a shorter PFS; OS results were not mature. Majority of patients (n = 362, 80%) initiated treatment with the United States FDA-approved starting dose of CDK4/6i. In all, 330 (72%) had at least one DD and 217 (48%) patients required at least one DR, but these dose modifications were not associated with poorer survival outcomes. Patients age ⩾70 were more likely to require dose modifications leading to a lower treatment dose. The most common reason for DD/DR was neutropenia (60%) and the incidence of febrile neutropenia was only 2%. Conclusions Our study indicates CDK4/6i is effective and safe. Age ⩾ 70, distant metastases to liver, peritoneal or brain were negative prognostic factors. Age ⩾ 70 was associated with significantly increased requirement for dose modification; however, this did not impact survival outcomes. These findings provide reassurance that survival outcomes are not adversely affected in elderly patients when DD/DR is indicated.
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Affiliation(s)
- Jia Li Low
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Elaine Lim
- Division of Medical Oncology, National Cancer Center Singapore, Singapore
| | - Lavina Bharwani
- Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
| | - Andrea Wong
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | | | - Samuel Ow
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Siew Eng Lim
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Matilda Lee
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Joan Choo
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Joline Lim
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Gloria Chan
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Robert John Walsh
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Vaishnavi Muthu
- Department of Medical Oncology, Tan Tock Seng Hospital, Singapore
| | - Natalie Ngoi
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
| | - Wanqin Chong
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore
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21
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Wong V, de Boer R, Baron-Hay S, Blum R, Boyle F, Chua S, Clarke K, Cuff K, Green M, Lim E, Mok K, Nott L, Nottage M, Tafreshi A, Tsoi D, Uccellini A, Hong W, Gibbs P, Lok SW. Real-World Outcomes of Ribociclib and Aromatase Inhibitor Use in First Line Hormone Receptor Positive, HER2-Negative Metastatic Breast Cancer. Clin Breast Cancer 2022; 22:792-800. [PMID: 36151018 DOI: 10.1016/j.clbc.2022.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND International guidelines recommend combining a CDK4/6 inhibitor and endocrine therapy (ET) as first line treatment for hormone receptor (HR) positive, HER2 negative metastatic breast cancer (MBC). Results from MONALEESA-2 demonstrate superior progression free survival (PFS) and overall survival (OS) with ribociclib (CDK4/6 inhibitor) and ET compared to ET alone. Real world outcomes have yet to be reported. MATERIALS AND METHODS KARMA is a non-interventional registry of Australian patients receiving first-line treatment with ribociclib and aromatase inhibitor (AI), obtained via a Medicine Access Program (MAP) for HR+, HER2- MBC. Outcomes were compared with the ribociclib/letrozole cohort in MONALEESA-2. RESULTS Data from 160 patients at 17 sites was analysed. Median follow-up is 36.5 months. Compared to MONALEESA-2, patients were numerically younger (54.3 vs. 62 years), with higher rates of bone-only metastases (31% vs. 21%). A total of 63 of 160 (39%) patients remain on treatment. A total of 56% of patients had at least 1 dose reduction, with neutropenia (68%) and abnormal liver enzymes (17%) the most common reasons. A total of 17 of 160 (11%) discontinued treatment due to toxicity, with no treatment related deaths. Median PFS was not reached (95% CI 29.9- NR), with PFS at 12 months and 18 months being 76% and 67% respectively versus 25.3 months, 73% and 63% in MONALEESA-2. CONCLUSION The ribociclib and AI combination was well tolerated in this real-world setting. The KARMA registry cohort achieved a superior PFS (>36.5 months) to MONALEESA-2, potentially due to more favourable baseline disease characteristics. Less frequent assessment scheduling in this non trial setting may also contribute.
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Affiliation(s)
- Vanessa Wong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
| | - Richard de Boer
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia; St Vincent's Private Hospital, Fitzroy, VIC, Australia
| | | | - Robert Blum
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | | | - Susan Chua
- Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Kerrie Clarke
- Albury Wodonga Regional Cancer Centre, Albury Wodonga Health, East Albury, NSW, Australia
| | - Katharine Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | | | - Elgene Lim
- St Vincent's Clinical School, University of New South Wales, NSW, Australia
| | - Kelly Mok
- Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Michelle Nottage
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ali Tafreshi
- Wollongong Private Hospital, Wollongong, NSW, Australia
| | - Daphne Tsoi
- St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - Anthony Uccellini
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, VIC, Australia
| | - Wei Hong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Sheau Wen Lok
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
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22
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Lux MP, Runkel ED, Glastetter E, Vannier C, Buncke J, Frank M, Bartsch R, Thill M, Wöckel A. PERFORM: a non-interventional study assessing the patients' treatment starting with 1L palbociclib in HR+/HER2- ABC. Future Oncol 2022; 18:3971-3982. [PMID: 36427183 DOI: 10.2217/fon-2022-0552] [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] [Indexed: 11/27/2022] Open
Abstract
The prospective, non-interventional PERFORM study describes and analyzes the effectiveness of palbociclib in combination with endocrine therapy (aromatase inhibitor or fulvestrant) as first-line treatment for patients with locally advanced or metastatic HR+/HER2- breast cancer in the real-world setting in Germany and Austria. PERFORM will reflect current patient characteristics and routine treatment patterns including treatment sequences and time to subsequent (chemo)therapy. Besides, second-line treatment effectiveness and patient-relevant end points such as longitudinal patient-reported outcome measurements beyond disease progression will be analyzed. Accounting for the heterogenous real-world patient population, data on clinicopathologic subgroups underrepresented in clinical trials such as elderly or male will be analyzed. Taken together, PERFORM will close knowledge gaps from clinical trials in real world.
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Affiliation(s)
- Michael Patrick Lux
- Department for Gynecology & Obstetrics, Frauen- und Kinderklinik St Louise, Husener Str. 81, Paderborn, 33098, Germany
| | | | | | | | - Johanna Buncke
- Pfizer Deutschland GmbH, Linkstr. 10, Berlin, 10785, Germany
| | - Melanie Frank
- iOMEDICO, Ellen-Gottlieb-Str. 19, Freiburg, 79106, Germany
| | - Rupert Bartsch
- Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Marc Thill
- Department of Gynecology & Gynecological Oncology, Agaplesion Markus Hospital, Wilhelm-Epstein-Str. 4, Frankfurt am Main, 60431, Germany
| | - Achim Wöckel
- University Hospital Würzburg, Josef-Schneider-Str. 4, Würzburg, 97080, Germany
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23
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Lim GH, Alcantara VS, Ng RP, Ng R, Allen JC, Htein MMW, Lim SH, Yan Z, Tan QT. Patterns of breast cancer second recurrences in patients after mastectomy. Breast Cancer Res Treat 2022; 196:583-589. [DOI: 10.1007/s10549-022-06772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022]
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Rugo HS, Brufsky A, Liu X, Li B, McRoy L, Chen C, Layman RM, Cristofanilli M, Torres MA, Curigliano G, Finn RS, DeMichele A. Real-world study of overall survival with palbociclib plus aromatase inhibitor in HR+/HER2- metastatic breast cancer. NPJ Breast Cancer 2022; 8:114. [PMID: 36220852 PMCID: PMC9553912 DOI: 10.1038/s41523-022-00479-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022] Open
Abstract
Data on real-world effectiveness of cyclin-dependent kinase 4/6 inhibitor combination therapy versus endocrine therapy alone are limited. The Flatiron Health Analytic Database was used to assess overall survival (OS) in patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative (HR+/HER2−) metastatic breast cancer (MBC) treated with first-line palbociclib plus an aromatase inhibitor (AI) versus an AI alone in routine US clinical practice. In total, 2888 patients initiated treatment during February 3, 2015–March 31, 2020, with a potential ≥6-month follow-up (cutoff date, September 30, 2020). After stabilized inverse probability treatment weighting, median OS (95% CI) is significantly longer among palbociclib versus AI recipients (49.1 [45.2–57.7] versus 43.2 [37.6–48.0] months; hazard ratio, 0.76 [95% CI, 0.65–0.87]; P < 0.0001). Progression-free survival (95% CI) is 19.3 (17.5–20.7) versus 13.9 (12.5–15.2) months, respectively (hazard ratio, 0.70 [95% CI, 0.62–0.78]; P < 0.0001). These data support first-line palbociclib plus an AI treatment for HR+/HER2− MBC. (Trial number NCT05361655).
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Affiliation(s)
- Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
| | - Adam Brufsky
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | - Rachel M Layman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Mylin A Torres
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS and University of Milano, Milan, Italy
| | - Richard S Finn
- David Geffen School of Medicine at University of California Los Angeles, Santa Monica, CA, USA
| | - Angela DeMichele
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Smith ER, Huang M, Schlumbrecht MP, George SH, Xu XX. Rationale for combination of paclitaxel and CDK4/6 inhibitor in ovarian cancer therapy — non-mitotic mechanisms of paclitaxel. Front Oncol 2022; 12:907520. [PMID: 36185294 PMCID: PMC9520484 DOI: 10.3389/fonc.2022.907520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Taxanes and CDK4/6 inhibitors (CDK4/6i) are two families of successful anti-mitotic drugs used in the treatment of solid tumors. Paclitaxel, representing taxane compounds, has been used either alone or in combination with other agents (commonly carboplatin/cisplatin) in the treatment of many solid tumors including ovarian, breast, lung, prostate cancers, and Kaposi’s sarcoma. Paclitaxel has been routinely prescribed in cancer treatment since the 1990s, and its prominent role is unlikely to be replaced in the foreseeable future. Paclitaxel and other taxanes work by binding to and stabilizing microtubules, causing mitotic arrest, aberrant mitosis, and cell death. CDK4/6i (palbociclib, ribociclib, abemaciclib) are relatively new cell cycle inhibitors that have been found to be effective in breast cancer treatment, and are currently being developed in other solid tumors. CDK4/6i blocks cell cycle progression at the G1 phase, resulting in cell death by mechanisms not yet fully elucidated. At first glance, paclitaxel and CDK4/6i are unlikely synergistic agents as both are cell cycle inhibitors that work at different phases of the cell cycle, and few clinical trials have yet considered adding CDK4/6i to existing paclitaxel chemotherapy. However, recent findings suggest the importance of a non-mitotic mechanism of paclitaxel in cancer cell death and pre-clinical data support rationale for a strategic paclitaxel and CDK4/6i combination. In mouse tumor model studies, drug sequencing resulted in differential efficacy, indicating complex biological interactions of the two drugs. This article reviews the rationales of combining paclitaxel with CDK4/6i as a potential therapeutic option in recurrent ovarian cancer.
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Affiliation(s)
- Elizabeth R. Smith
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Obstetrics, Gynecology and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Marilyn Huang
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Obstetrics, Gynecology and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Matthew P. Schlumbrecht
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Obstetrics, Gynecology and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sophia H.L. George
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Obstetrics, Gynecology and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Xiang-Xi Xu
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Xiang-Xi Xu,
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26
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Price GL, Sudharshan L, Ryan P, Rajkumar J, Sheffield KM, Nash Smyth E, Morato Guimaraes C, Rybowski S, Cuyun Carter G, Gathirua-Mwangi WG, Huang YJ. Real world incidence and management of adverse events in patients with HR+, HER2- metastatic breast cancer receiving CDK4 and 6 inhibitors in a United States community setting. Curr Med Res Opin 2022; 38:1319-1331. [PMID: 35535675 DOI: 10.1080/03007995.2022.2073122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the real-world incidence and management of select adverse events (AEs) among female patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC), receiving a cyclin-dependent kinase 4 and 6 (CDK4 and 6) inhibitor (palbociclib, abemaciclib, or ribociclib). METHODS This retrospective study analyzed data from the US Oncology Network iKnowMed electronic health record database for 396 patients with an initial MBC diagnosis on/after 1 January 2014 and receipt of first CDK4 and 6 regimen between 1 January 2017 and 31 December 2018. In this descriptive study, the proportion of patients who experienced select AEs and associated dose modifications or discontinuations were reported. The occurrence of select healthcare resource utilization categories was also reported. RESULTS Median follow-up time was 451, 262, and 355 days for patients in the palbociclib, abemaciclib, and ribociclib cohorts, respectively. The most common AEs were neutropenia (palbociclib, 44.8%; abemaciclib, 10.6%; ribociclib, 36.3%), diarrhea (palbociclib, 8.0%; abemaciclib, 43.0%; ribociclib, 8.8%), and fatigue (palbociclib, 12.9%; abemaciclib, 17.6%; ribociclib, 16.5%). AEs resulted in a treatment hold among 91 (23.0%), a dose reduction among 86 (21.7%), and permanent discontinuation among 48 (12.1%) patients overall. CONCLUSIONS This real-world study provides insight into the occurrence of AEs which varied by CDK4 and 6 inhibitor. Compared to clinical trials, frequencies of AEs were numerically lower but dose reductions due to AEs were numerically higher. It is possible these differences reflect proactive management of AEs on the part of clinicians to help patients remain on therapy.
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Affiliation(s)
| | | | - Paula Ryan
- Texas Oncology - The Woodlands, The Woodlands, TX, USA
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Engler T, Fasching PA, Lüftner D, Hartkopf AD, Müller V, Kolberg HC, Hadji P, Tesch H, Häberle L, Ettl J, Wallwiener M, Beckmann MW, Hein A, Belleville E, Uhrig S, Wimberger P, Hielscher C, Kurbacher CM, Wuerstlein R, Untch M, Taran FA, Enzinger HM, Krabisch P, Welslau M, Maasberg M, Hempel D, Lux MP, Michel LL, Janni W, Wallwiener D, Brucker SY, Fehm TN, Schneeweiss A. Implementation of CDK4/6 Inhibitors and its Influence on the Treatment Landscape of Advanced Breast Cancer Patients - Data from the Real-World Registry PRAEGNANT. Geburtshilfe Frauenheilkd 2022; 82:1055-1067. [PMID: 36186151 PMCID: PMC9525148 DOI: 10.1055/a-1880-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 10/31/2022] Open
Abstract
Background Comprehensive data from prospective clinical trials have led to a high level of evidence establishing CDK4/6 inhibitors in combination with endocrine treatment (CDK4/6i + ET) as a standard for the treatment of HER2-negative, hormone receptor-positive (HER2- HR+) breast cancer patients in the first-line advanced therapy setting. Data on patient populations that have been treated in the real-world setting may provide an insight into changes of patient characteristics and prognosis over time. Methods The data were extracted from the prospective real-world registry PRAEGNANT (NCT02338167). Patients had to have HER2- HR+ advanced breast cancer in the first-line metastatic setting. The chosen therapies were described as well as progression-free survival (PFS) and overall survival (OS) in relation to the given therapies and time periods during which they were indicated. Results CDK4/6 inhibitors have been rapidly implemented since their introduction in November 2016. In recent years (2018 - 2022), about 70 - 80% of the patient population have been treated with CDK4/6 inhibitors, while endocrine monotherapy was given to about 10% and chemotherapy to about 15% of all patients. The prognosis was worst in patients treated with chemotherapy. Recently, mainly patients with a good prognosis are being treated with endocrine monotherapy, and patients who are treated with chemotherapy have an unfavorable prognosis. The PFS and OS of patients treated with CDK4/6i + ET have remained similar over time despite changes in patient characteristics. Conclusion A treatment with CDK4/6i + ET has rapidly become the therapy standard for patients in the first-line advanced breast cancer setting. After the implementation of CDK4/6i + ET, endocrine monotherapy is only given to patients with a very favorable prognosis, while chemotherapy is provided to patients with a rather unfavorable prognosis. These changes in patient characteristics did not seem to influence the prognosis of patients treated with CDK4/6i + ET.
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Affiliation(s)
- Tobias Engler
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany,Correspondence Peter A. Fasching, MD Department of Gynecology and Obstetrics, Erlangen University HospitalComprehensive Cancer
Center Erlangen EMNFriedrich Alexander University of Erlangen–NurembergUniversitätsstraße 21 – 2391054
ErlangenGermany
| | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
| | - Andreas D. Hartkopf
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | | | - Peyman Hadji
- Frankfurt Center for Bone Health, Frankfurt am Main, Germany; Philips-University of Marburg, Marburg, Germany
| | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt am Main, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany
| | | | - Sabrina Uhrig
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen–Nuremberg, Erlangen,
Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Carl Gustav Carus Faculty of Medicine and University Hospital, TU Dresden, Dresden, Germany,National Center for Tumor Diseases (NCT), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Carl Gustav Carus Faculty of Medicine and University
Hospital, TU Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany,German Cancer Consortium (DKTK), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carsten Hielscher
- Gynäkologie Kompetenzzentrum – Onkologisches Zentrum Stralsund, Stralsund, Germany
| | - Christian M. Kurbacher
- Department of Gynecology I (Gynecologic Oncology), Gynecologic Center Bonn-Friedensplatz, Bonn, Germany
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics, Breast Center and CCC Munich, Munich University Hospital, Munich, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin-Buch, Berlin, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, Freiburg University Hospital, Freiburg, Germany
| | - Hans-Martin Enzinger
- Department of Gynecology and Obstetrics, Klinikum Bamberg, Sozialstiftung Bamberg, Bamberg, Germany
| | - Petra Krabisch
- Department of Gynecology and Obstetrics, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | | | | | - Dirk Hempel
- Onkologiezentrum Donauwörth, Donauwörth, Germany
| | - Michael P. Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise, Paderborn, Germany; Frauenklinik St. Josefs-Krankenhaus, Salzkotten, Germany; Kooperatives Brustzentrum
Paderborn, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Laura L. Michel
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y. Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Marineau A, St-Pierre C, Lessard-Hurtubise R, David MÈ, Adam JP, Chabot I. Cyclin-dependent kinase 4/6 inhibitor treatment use in women treated for advanced breast cancer: Integrating ASCO/NCODA patient-centered standards in a community pharmacy. J Oncol Pharm Pract 2022:10781552221102884. [PMID: 35642282 DOI: 10.1177/10781552221102884] [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: 11/16/2022]
Abstract
BACKGROUND Outpatients treated with oral anti-cancer drugs, including selective cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), may benefit from a pharmacy practice setting adapted to support proper oral anti-cancer drug monitoring. This real-world study aimed to characterize patient-centered pharmacy practice aligned with American Society of Clinical Oncology (ASCO)/National Community Oncology Dispensing Association (NCODA) standards and to describe its impact on CDK4/6i treatment use. METHODS This retrospective study included women with confirmed hormone receptor-positive/human epidermal growth factor 2 negative locally advanced or metastatic breast cancer treated with either palbociclib, abemaciclib or ribociclib combined with letrozole or fulvestrant. Pharmacists collected patient characteristics, clinical activities, and treatment patterns using data from the pharmacy chart. CDK4/6i treatment adherence rates were estimated based on medication claims data. Time-to-treatment discontinuation, a proxy for time-to-event, was assessed using the Kaplan-Meier estimate. RESULTS Of the 195 patients assessed for eligibility, 65 were included in this study. The median observation duration was 13.6 months. An average of seven pharmaceutical care activities (range 2.8-21.7) per patient was documented for each treatment cycle. The mean proportion of days covered was 89.6%. The median time-to-treatment discontinuation was estimated at 44.2 months in patients treated with CDK4/6i + letrozole and 17.0 months in patients treated with CDK4/6i + fulvestrant. The average relative dose intensity was 85%, and the benefits of treatment were maintained regardless of the relative dose intensity levels. CONCLUSION A structured patient-centered pharmacy practice model integrating the ASCO/NCODA patient-centered standards and ongoing communication with patients and healthcare providers ensure timely refills, close monitoring, and allows patients to achieve high adherence and persistence rates comparable to those reported in clinical trials.
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Affiliation(s)
| | | | | | | | - Jean-Philippe Adam
- Department of Pharmacy, Centre hospitalier de l'Université de Montréal, Montréal, Canada.,CHUM Research Center, CHUM, Montréal, Canada
| | - Isabelle Chabot
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
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Patt D, Liu X, Li B, McRoy L, Layman RM, Brufsky A. Real-World Treatment Patterns and Outcomes of Palbociclib Plus an Aromatase Inhibitor for Metastatic Breast Cancer: Flatiron Database Analysis. Clin Breast Cancer 2022; 22:601-610. [DOI: 10.1016/j.clbc.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/11/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
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Cardoso Borges F, Alves da Costa F, Ramos A, Ramos C, Bernardo C, Brito C, Mayer-da-Silva A, Furtado C, Ferreira AR, Martins-Branco D, Miranda A, Lourenço A. Real-world effectiveness of palbociclib plus fulvestrant in advanced breast cancer: Results from a population-based cohort study. Breast 2022; 62:135-143. [PMID: 35182993 PMCID: PMC8859011 DOI: 10.1016/j.breast.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background Real-world (RW) data may provide valuable information on the effectiveness and safety of medicines, which is particularly relevant for clinicians, patients and third-party payers. Evidence on the effectiveness of palbociclib plus fulvestrant is scarce, which highlights the need of additional studies. The aim of this study was to evaluate the effectiveness of palbociclib plus fulvestrant in advanced breast cancer (ABC). Materials and methods We conducted a population-based retrospective cohort study and cases of interest were identified through the Portuguese National Cancer Registry database and additional data sources. Patients aged≥18 years, diagnosed with ABC and exposed to palbociclib plus fulvestrant between May 31, 2017 and March 31, 2019 were included. Patients were followed-up until death or cut-off date (February 28, 2021). Primary outcome was rw-progression-free survival (rwPFS). Secondary outcomes were rw-overall survival (rwOS), rw-time to palbociclib failure (rwTPF) and rw-time to next treatment (rwTTNT). Results A total of 210 patients were included. Median age was 58 years (range 29–83) and 99.05% were female. Median follow-up time was 23.22 months and, at cut-off date, treatment had been discontinued in 189 patients, mainly due to disease progression (n = 152). Median rwPFS was 7.43 months (95% confidence interval [CI] 6.28–9.05) and 2-year rwPFS was 16.65% (95%CI 11.97–22.00). Median rwOS was 24.70 months (95%CI 21.58–29.27), median rwTPF was 7.5 months (95%CI 6.51–9.08) and median rwTTNT was 11.74 months (95%CI 10.33–14.08). Conclusion Palbociclib plus fulvestrant seems an effective treatment for ABC in real-world context. Compared to registrations studies, rwPFS and rwOS were shorter in real-life setting. Palbociclib plus fulvestrant seems to be an effective therapy for ABC in real-world. Median rwPFS and rwOS were estimated at 7.43 and 24.70 months, respectively. Our data suggest lower effectiveness in real-world than the efficacy reported. Treatment was discontinued due to AEs in 8.09% of patients, suggesting good tolerability. Registries may generate effectiveness data and support clinical and HTA decisions.
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Affiliation(s)
- Fábio Cardoso Borges
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Filipa Alves da Costa
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal; Department of Pharmacy, Pharmacology and Health Technologies, Faculty of Pharmacy, University of Lisbon (FFULisboa), Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
| | - Adriana Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Catarina Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Catarina Bernardo
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Cláudia Brito
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Alexandra Mayer-da-Silva
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Cláudia Furtado
- Health Technology Assessment Department, Autoridade Nacional Do Medicamento e Produtos de Saúde (INFARMED), Parque da Saúde de Lisboa, Avenida Do Brasil, 53, 1749-004, Lisboa, Portugal.
| | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisboa, Portugal.
| | - Diogo Martins-Branco
- Academic Trials Promoting Team, Institute Jules Bordet, Rue Meylemeersch 90, 1070, Bruxelles, Belgium; Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Ana Miranda
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - António Lourenço
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
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Bardia A, Cortes J, Hurvitz SA, Delaloge S, Iwata H, Shao ZM, Kanagavel D, Cohen P, Liu Q, Cartot-Cotton S, Pelekanou V, O’Shaughnessy J. AMEERA-5: a randomized, double-blind phase 3 study of amcenestrant plus palbociclib versus letrozole plus palbociclib for previously untreated ER+/HER2– advanced breast cancer. Ther Adv Med Oncol 2022; 14:17588359221083956. [PMID: 35309087 PMCID: PMC8928355 DOI: 10.1177/17588359221083956] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: For estrogen receptor–positive (ER+)/human epidermal growth factor receptor 2–negative (HER2–) advanced breast cancer (ABC), the current standard first-line treatment includes an aromatase inhibitor in combination with a cyclin-dependent kinase 4/6 inhibitor. When resistance occurs, often related to the occurrence of ESR1 mutations, selective estrogen receptor modulators or degraders (SERDs) may be used, alone or in combination regimens. Amcenestrant (SAR439859), an optimized oral SERD, has shown clinical antitumor activity in combination with palbociclib in patients with ER+/HER2– ABC and, as monotherapy, in patients with and without ESR1 mutations. Here, we describe the study design of AMEERA-5, an ongoing, prospective, phase 3, randomized, double-blind, multinational study comparing the efficacy and safety of amcenestrant plus palbociclib versus letrozole plus palbociclib in patients with advanced (locoregional recurrent or metastatic) ER+/HER2– breast cancer. Methods: Patients are pre-/postmenopausal women and men with no prior systemic therapy for ABC. The planned enrollment is 1066 patients. Patients are randomized 1:1 to either amcenestrant 200 mg plus palbociclib 125 mg or letrozole 2.5 mg plus palbociclib 125 mg. Amcenestrant, letrozole, and their matching placebos are taken once daily continuously; palbociclib is taken once daily for 21 days, followed by 7 days off-treatment for a 28-day cycle. Treatment continues until disease progression, unacceptable toxicity, or decision to stop treatment. Pre-/perimenopausal women and men receive goserelin subcutaneously. Randomization is stratified by de novo metastatic disease, menopausal status, and visceral metastases. The primary endpoint is progression-free survival. The key secondary endpoint is overall survival; others are safety, pharmacokinetics, and quality of life. Conclusions: AMEERA-5 is evaluating the efficacy and safety of amcenestrant in combination with palbociclib as first-line therapy in pre-/postmenopausal women and men with ER+/HER2– ABC. ClinicalTrials Identifier: NCT04478266.
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Affiliation(s)
- Aditya Bardia
- Oncology/Hematology, Massachusetts General Hospital, Harvard Medical School, BHX-237, 55 Fruit Street, Boston, MA 02114, USA
| | - Javier Cortes
- Oncology Department, International Breast Cancer Center (IBCC), Barcelona, Spain
| | - Sara A. Hurvitz
- Breast Medical Oncology, University of California Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | - Hiroji Iwata
- Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | | | - Patrick Cohen
- Research and Development, Sanofi, Vitry-sur-Seine, France
| | - Qianying Liu
- Research and Development, Sanofi, Cambridge, MA, USA
| | | | | | - Joyce O’Shaughnessy
- Oncology/Internal Medicine, Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA
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The Impact of Real-World Alternative Dosing Strategies of Palbociclib on Progression-Free Survival in Patients with Metastatic Breast Cancer. Curr Oncol 2022; 29:1761-1772. [PMID: 35323345 PMCID: PMC8946878 DOI: 10.3390/curroncol29030145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Palbociclib, a cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitor, in combination with letrozole or fulvestrant has been demonstrated to prolong the progression-free survival (PFS) in patients with hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) metastatic breast cancer. In efforts to mitigate neutropenic toxicities, oncologists in real-world practice have prescribed alternative dosing strategies with palbociclib, yet the implication on PFS is unknown. Methods: We conducted a retrospective, observational chart review of all female patients at our clinics with HR+, HER2- metastatic breast cancer receiving palbociclib in combination with either letrozole or fulvestrant with a first dose initiated between June 2016 and December 2018 and followed their disease course until 30 April 2020. Results: The median PFS for all clinic patients receiving palbociclib and letrozole (n = 63) was 40.8 months (95% confidence interval (CI) 25.6–not estimable) and 16.97 months (95% CI 8.57–not estimable) for patients receiving palbociclib and fulvestrant (n = 11). We identified seven alternative dosing strategies prescribed by oncologists, the most prevalent being prescribing palbociclib for three weeks on and two weeks off (n = 8). The Kaplan–Meier curves for PFS in patients receiving letrozole and palbociclib prescribed alternative dosing strategies appear to diverge from monograph dosing early in the treatment. Many patients prescribed palbociclib using alternative dosing strategies continued to be observed even by the 18-month timepoint. The prevalence of grade 4 neutropenia was lower for patients on palbociclib with letrozole, suggesting a possible mitigation of severe neutropenia with alternative dosing strategies. Conclusions: We conclude that alternative dosing strategies used by oncologists such as prescribing palbociclib for three weeks on, two weeks off may achieve comparable disease control while mitigating neutropenic toxicities when compared to standard monograph dosing recommendations, prolonging treatment tolerability and adherence. Further large-scale studies are needed to confirm these results for future clinical adoption.
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D'Amico P, Cristofanilli M. Standard of Care in Hormone Receptor-Positive Metastatic Breast Cancer: Can We Improve the Current Regimens or Develop Better Selection Tools? JCO Oncol Pract 2021; 18:331-334. [PMID: 34780297 DOI: 10.1200/op.21.00707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paolo D'Amico
- Department of Medicine-Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Massimo Cristofanilli
- Department of Medicine-Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Kartika ID, Kotani H, Iida Y, Koyanagi A, Tanino R, Harada M. Protective role of cytoplasmic p21Cip1/Waf1 in apoptosis of CDK4/6 inhibitor-induced senescence in breast cancer cells. Cancer Med 2021; 10:8988-8999. [PMID: 34761877 PMCID: PMC8683524 DOI: 10.1002/cam4.4410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 12/11/2022] Open
Abstract
Inhibition of CDK4/6 slows the cell cycle and induces senescence in breast cancer cells. However, senescent cancer cells promote invasion and metastasis. Several drugs reportedly target senescent cells, including ABT‐263 (navitoclax). We examined the effects of the CDK4/6 inhibitor abemaciclib and ABT‐263 on two human breast cancer cell lines. The abemaciclib and ABT‐263 combination additively decreased the viability of MDA‐MB‐231 cells, but not MCF‐7 cells. Also, the combination therapy‐induced caspase‐dependent apoptosis in MDA‐MB‐231 cells. Combination therapy with abemaciclib and ABT‐737, an ABT‐263 analog, significantly suppressed the in vivo growth of MDA‐MB‐231 with transient body‐weight loss. Given that p16Ink4a and p21Cip1/Waf1 are key factors in senescence and that both cell lines were negative for p16, the role of p21 in apoptosis of treated breast cancer cells was investigated. Although abemaciclib increased the cytoplasmic p21 level in both cell lines as a hallmark of senescence, the abemaciclib and ABT‐263 combination decreased it only in MDA‐MB‐231 cells. This decrease of p21 expression was relieved by caspase inhibition, and p21 was colocalized with caspase‐3 in the cytoplasm of MDA‐MB‐231 cells. Alternatively, small interfering RNA‐mediated knockdown of p21 rendered caspase‐3‐negative MCF‐7 cells susceptible to abemaciclib and ABT‐263, as well as TNF‐related apoptosis‐inducing ligand. Furthermore, a clinical database analysis showed that p21high breast cancer patients had a poorer prognosis compared to p21low patients. These results suggest that cytoplasmic p21 plays a protective role in apoptosis of CDK4/6 inhibitor‐induced senescent breast cancer cells.
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Affiliation(s)
- Irna D Kartika
- Department of Immunology, Shimane University Faculty of Medicine, Shimane, Japan.,Department of Clinical Pathology, Faculty of Medicine, University of Muslim Indonesia, Sulawesi, Indonesia
| | - Hitoshi Kotani
- Department of Immunology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yuichi Iida
- Department of Immunology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Akira Koyanagi
- Department of Immunology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Ryosuke Tanino
- Division of Medical Oncology & Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, Shimane, Japan
| | - Mamoru Harada
- Department of Immunology, Shimane University Faculty of Medicine, Shimane, Japan
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Brufsky A, Liu X, Li B, McRoy L, Layman RM. Real-World Tumor Response of Palbociclib Plus Letrozole Versus Letrozole for Metastatic Breast Cancer in US Clinical Practice. Target Oncol 2021; 16:601-611. [PMID: 34338965 PMCID: PMC8484164 DOI: 10.1007/s11523-021-00826-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited information exists regarding tumor response to palbociclib plus an aromatase inhibitor (AI) versus AI alone in real-world practice. OBJECTIVE To evaluate the real-world tumor response of palbociclib plus letrozole (PAL+LET) versus LET alone as first-line treatment for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer (HR+/HER2‒ MBC) in routine US clinical practice. PATIENTS AND METHODS This retrospective analysis included HR+/HER2‒ MBC patients who initiated PAL+LET or LET as first-line treatment between February 2015 and September 2018 in the Flatiron Health Analytics database. Patients were followed until December 2018. Real-world best tumor response (rwBTR) was determined based on physicians' assessment of radiologic evidence for change in burden of disease. RESULTS Of the 1383 eligible patients who initiated PAL+LET or LET as first-line therapy in the Flatiron database, 968 patients had ≥ 1 tumor response assessment (662 received PAL+LET and 306 received LET). The rwBTR rate (complete response+partial response) in the first-line setting was 59.8% in the PAL+LET group and 39.2% in the LET group (odds ratio 2.31 (95% CI 1.75‒3.04), P < 0.0001). After 1:1 propensity-score matching, the rwBTR rate was 58.6% in the PAL+LET group versus 39.1% in the LET group (odds ratio 2.21 (95% CI 1.50‒3.25), P < 0.0001). CONCLUSIONS This real-world analysis demonstrated that HR+/HER2‒ MBC patients were more likely to respond to PAL+LET compared to LET. These findings further showed the effectiveness of PAL+LET therapy in the real-world setting and support the combination as a standard of care for MBC. STUDY REGISTRATION Pfizer; NCT04176354; registered November 25, 2019.
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Affiliation(s)
- Adam Brufsky
- College of Medicine, University of Pittsburgh, 300 Halket St., Suite 4628, Pittsburgh, PA, 15213, USA.
| | | | | | | | - Rachel M Layman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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