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Schäffler H, Mergel F, Pfister K, Lukac S, Fink A, Veselinovic K, Rack B, Fink V, Leinert E, Dimpfl M, Englisch A, Tegeler CM, Seller A, Grischke EM, Hahn M, Volmer LL, Engler T, Frevert ML, Taran FA, Janni W, Brucker SY, Hartkopf AD, Dannehl D. The Clinical Relevance of the NATALEE Study: Application of the NATALEE Criteria to a Real-World Cohort from Two Large German Breast Cancer Centers. Int J Mol Sci 2023; 24:16366. [PMID: 38003555 PMCID: PMC10671738 DOI: 10.3390/ijms242216366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
The NATALEE study showed a significant benefit in invasive disease-free survival (iDFS) for patients with HR+/HER2- early breast cancer (eBC) at intermediate and high risk of recurrence who were treated with the CDK4/6 inhibitor Ribociclib in combination with endocrine therapy (ET). This retrospective study aims to apply the NATALEE inclusion criteria to a representative real-world cohort to estimate the proportion of HR+/HER2- breast cancer patients eligible for adjuvant Ribociclib therapy. Patients who underwent full surgical treatment for eBC between January 2018 and December 2020 at two large German university breast cancer centers (University of Ulm, University of Tuebingen) were included. Descriptive statistics were used to characterize the patient population eligible for Ribociclib treatment based on the NATALEE study's inclusion criteria. Out of 2384 enrolled patients, 1738 had HR+/HER2- eBC, of whom 43% (747/1738) met the NATALEE inclusion criteria. Of note, these patients were older, received less chemotherapy and presented with less advanced tumor stages compared to the NATALEE study cohort. Additionally, compared to the NATALEE study cohort, fewer patients had lymph node involvement (72.4% vs. 88.7%). Our analysis suggests that approximately 43% of all HR+/HER2- breast cancer patients will qualify for Ribociclib treatment. Given the numerous treatment options for patients with HR+/HER2- eBC, as well as the differences between the NATALEE cohort and patients in the real-world clinical setting, future analyses will be needed to determine which patients would benefit most from adjuvant CDK4/6 inhibitor treatment.
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Affiliation(s)
- Henning Schäffler
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Franziska Mergel
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Stephan Lukac
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Angelina Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Moritz Dimpfl
- Department of Gynecology and Obstetrics, University Hospital Mannheim, 68135 Mannheim, Germany;
| | - Alexander Englisch
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Christian Martin Tegeler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Anna Seller
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Eva-Maria Grischke
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Léa Louise Volmer
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Tobias Engler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Marie Louise Frevert
- Department of Obstetrics and Gynecology, University of Freiburg, 79106 Freiburg, Germany; (M.L.F.)
| | - Florin Andrei Taran
- Department of Obstetrics and Gynecology, University of Freiburg, 79106 Freiburg, Germany; (M.L.F.)
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Andreas Daniel Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Dominik Dannehl
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
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Perrone M, Giuliani F, Sanna V, Bruno S, Melaccio A, Santoro AN, Laface C, Maselli FM, Iaia ML, Guarini C, Fancellu A, Fedele P. Advances in pharmacotherapies that target the cell cycle for treatment of breast cancer: where are we at today? Expert Opin Pharmacother 2023; 24:887-900. [PMID: 37038927 DOI: 10.1080/14656566.2023.2201373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Advances in pharmacotherapies that target cell cycle in breast cancer have transformed the therapeutic armamentarium of breast oncology leading to the approval of CDK4/6 inhibitors plus endocrine therapy as the upfront treatment in the HR+/HER2- metastatic setting. The current challenge is to evaluate the efficacy of these drugs in the early setting. The current challenge is to evaluate the efficacy of these drugs in the early setting. Research is also making progress for other breast cancer subtypes (triple negative and HER 2+ breast cancer). AREAS COVERED The aim of this review is to summarize the recent therapeutic updates regarding the efficacy of CDK4/6 inhibitors in the metastatic and early setting for the treatment of HR+/HER2- breast cancer. The review also presents data regarding the clinical role of CDK4/6 inhibitors in HER2+, triple negative breast cancer and on therapeutic sequences in resistant tumors. A comprehensive search for the literature was conducted using MEDLINE, ASCO, ESMO and SABCS databases. EXPERT OPINION The therapeutic paradigm of breast cancer involving CDK4/6 inhibitors presents some still open discussion points. Further evidence regarding the best treatment strategy in HR+ HER2- metastatic breast cancer and the efficacy of CDK 4/6is in the early stage will be necessary in the next future. Predictive biomarkers of response or resistance need to be validated.
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Affiliation(s)
- Martina Perrone
- Francavilla Fontana Ceglie Messapica Hospital District, Oncology Unit. Francavilla Fontana, Puglia, Italy
| | | | - Valeria Sanna
- Sassari University Hospital, Oncology Unit. Sassari, IT
| | - Stefania Bruno
- San Paolo Hospital, Oncology Unit, ASL Bari. Bari, Puglia, IT
| | | | - Anna Natalizia Santoro
- Francavilla Fontana Ceglie Messapica Hospital District, Oncology Unit. Francavilla Fontana, Puglia, Italy
| | - Carmelo Laface
- Francavilla Fontana Ceglie Messapica Hospital District, Oncology Unit. Francavilla Fontana, Puglia, Italy
| | - Felicia Maria Maselli
- Francavilla Fontana Ceglie Messapica Hospital District, Oncology Unit. Francavilla Fontana, Puglia, Italy
| | - Maria Laura Iaia
- Francavilla Fontana Ceglie Messapica Hospital District, Oncology Unit. Francavilla Fontana, Puglia, Italy
| | - Chiara Guarini
- Francavilla Fontana Ceglie Messapica Hospital District, Oncology Unit. Francavilla Fontana, Puglia, Italy
| | - Alessandro Fancellu
- Sassari University Hospital Department of Surgery, Dept. of Medical, Surgical and Experimental Sciences, Unit of General Surgery. Sassari, IT
| | - Palma Fedele
- Francavilla Fontana Ceglie Messapica Hospital District, Oncology Unit. Francavilla Fontana, Puglia, Italy
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