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Treatment patterns and clinical outcomes in patients with metastatic breast cancer treated with palbociclib-based therapies: real-world data in the Han population. Chin Med J (Engl) 2022; 135:1734-1741. [PMID: 35984107 PMCID: PMC9509029 DOI: 10.1097/cm9.0000000000002240] [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] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This study aimed to reveal the treatment patterns and clinical outcomes of diverse palbociclib-based regimens in Han patients with estrogen receptor-positive (ER+) metastatic breast cancer in routine clinical practice. METHODS The clinical data of patients with ER+ metastatic breast cancer treated with palbociclib were collected from the National Cancer Center database. The efficacy profile of palbociclib in this Han population was evaluated, especially for various combination regimens. The efficacy of palbociclib-based therapy in patients with prior everolimus treatment was also assessed. RESULTS A total of 186 patients from 89 cities in 18 provinces in China were enrolled. The median progression-free survival (PFS) was similar among different palbociclib-combined groups ( P = 0.566): 10.0 months (95% confidence interval [CI] 3.8-16.1) in the +exemestane group, 9.7 months (95% CI 6.3-13.1) in the +letrozole group, 7.8 months (95% CI 5.5-10.2) in the +fulvestrant group, 7.2 months (95% CI 3.2-11.3) in the +toremifene group, and 6.1 months (95% CI 1.2-11.0) in the +anastrozole group. Thirty-four patients (18.3%) had received everolimus for their metastatic disease before the prescription of palbociclib. The disease control rate was significantly lower in patients who had received previous everolimus than in the everolimus-naïve group (50.0% vs . 82.2%, P < 0.001). Patients pre-treated with everolimus had significantly worse PFS than those in the everolimus-naïve group (3.4 months vs . 8.8 months, P = 0.001). After propensity score matching, patients pre-treated with everolimus had similar PFS (4.4 months, 95% CI 0.5-8.2) compared with everolimus-naïve patients (6.1 months, 95% CI 4.7-7.5, P = 0.439). CONCLUSIONS Various palbociclib-based regimens have promising efficacy in ER+ metastatic breast cancer in real-world settings, even in patients who had been pre-treated with everolimus.
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Li J, Zhang X, Yang C, Lv Y, Yang H, Kong X, Han M, Wang Z, Ma J, Han J, Liu Y. Real-world effectiveness and sensitivity of palbociclib plus endocrine therapy in HR+/HER2- patients with metastatic breast cancer. Medicine (Baltimore) 2021; 100:e27710. [PMID: 34871262 PMCID: PMC8568379 DOI: 10.1097/md.0000000000027710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/18/2021] [Indexed: 12/24/2022] Open
Abstract
Palbociclib has shown satisfactory outcomes when combined with endocrine therapy (ET) in hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (MBC). However, data in Asia are currently scarce.This retrospective study aimed to evaluate the real-world effectiveness, sensitivity, and toxicity of palbociclib plus ET in HR+/HER2- MBC in North China. We recruited patients with HR+/HER2- MBC from August 2018 to July 2020 across 7 hospitals in North China. The primary endpoint was to evaluate progression-free survival (PFS) after initial progress on palbociclib therapy. The secondary endpoints included determining predictive biomarkers of palbociclib sensitivity and toxicity of palbociclib.A total of 54 patients were analyzed in this cohort with an estimated median follow-up time of 14.3 months. Patients who received palbociclib as a first-line treatment showed significantly prolonged PFS compared with those who received palbociclib as a second-line or beyond treatment (21.8 months vs 15.9 months vs 6.8 months) (P < .001). Besides, patients with Ki67 <30% (P = .024) and PR ≥20% (P = .041) in metastatic tumors had significantly longer PFS. The Cox proportional-hazards regression analyses proved that different lines (P = .001 in multivariate analysis), Ki67 <30% (P = .035 in multivariate analysis), and PR ≥20% (P = .045 in univariate analysis) in metastatic tumors affected PFS significantly. The most common adverse events were hematologic, with 31.48% of patients having neutropenia.Palbociclib plus ET significantly prolonged PFS for patients with HR+/HER2- MBC who received first-line therapy, with manageable toxicity. The values of Ki67 and PR in metastatic tumors may be potential predictive biomarkers of palbociclib sensitivity.
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Affiliation(s)
- Jingping Li
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangmei Zhang
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, China
| | - Chao Yang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, China
| | - Yalei Lv
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hua Yang
- Department of Internal Medicine, Affiliated Hospital of Hebei University, Baoding, China
| | - Xiangshun Kong
- Department of Breast Cancer, People's Hospital of Xingtai City, Xingtai, China
| | - Meng Han
- Department of Breast Cancer, First Hospital of Qinhuangdao City, Qinhuangdao, China
| | - Zunyi Wang
- Department of Breast Cancer, Center Hospital of Cangzhou City, Cangzhou, China
| | - Jie Ma
- Department of Breast Cancer, People's Hospital of Tangshan City, Tangshan, China
| | - Jianjun Han
- Department of Breast Cancer, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Yunjiang Liu
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, China
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Twelves C, Bartsch R, Ben-Baruch NE, Borstnar S, Dirix L, Tesarova P, Timcheva C, Zhukova L, Pivot X. The Place of Chemotherapy in The Evolving Treatment Landscape for Patients With HR-positive/HER2-negative MBC. Clin Breast Cancer 2021; 22:223-234. [PMID: 34844889 DOI: 10.1016/j.clbc.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/23/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
Endocrine therapy (ET) for the treatment of patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR-positive/HER2-negative) metastatic breast cancer (MBC) has changed markedly over recent years with the emergence of new ETs and the use of molecularly targeted agents. Cytotoxic chemotherapy continues, however, to have an important role in these patients and it is important to maximize its efficacy while minimizing toxicity to optimize outcomes. This review examines current HR-positive/HER2-negative MBC clinical guidelines and addresses key questions around the use of chemotherapy in the face of emerging therapeutic options. Specifically, the indications for chemotherapy in patients with HR-positive/HER2-negative MBC and the choice of optimal chemotherapy are discussed.
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Affiliation(s)
- Chris Twelves
- Clinical Cancer Pharmacology and Oncology, Leeds Institute of Medical Research, University of Leeds and Leeds Teaching Hospitals Trust Leeds.
| | - Rupert Bartsch
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, Austria
| | | | - Simona Borstnar
- Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Luc Dirix
- Medical Oncology, Sint-Augustinus Hospital, Antwerp, Belgium
| | - Petra Tesarova
- First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | | | | | - Xavier Pivot
- ICANS - Strasbourg Europe Cancerology Institute, Strasbourg, France
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4
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Jeong H, Jeong JH, Kim JE, Ahn JH, Jung KH, Kim SB. Comparison of the Effectiveness and Clinical Outcome of Everolimus Followed by CDK4/6 Inhibitors with the Opposite Treatment Sequence in Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer. Cancer Res Treat 2021; 54:469-477. [PMID: 34176251 PMCID: PMC9016296 DOI: 10.4143/crt.2021.205] [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: 02/10/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose In hormone receptor-positive, human epidermal growth factor receptor 2–negative metastatic breast cancer (HR+ HER2− MBC), the mainstay treatment options include cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) and everolimus (EVE) in combination with endocrine treatment. This study aims to compare the outcomes of the following treatment sequences: CDK4/6i followed by EVE and EVE followed by CDK4/6i. Materials and Methods Data from HR+ HER2− MBC patients treated between January 2014 and November 2020 with both CDK4/6i and EVE were retrospectively analyzed. Results Among the 88 patients included in the study, 51 received CDK4/6i before EVE (C→E group), and 37 received EVE before CDK4/6i (E→C group) with endocrine treatment. More patients in the E→C group had endocrine resistance (13.7% vs. 40.5%), experienced palliative chemotherapy (7.8% vs. 40.5%), and were heavily treated (treated as ≥ 3rd line, 5.9% vs. 40.5%). Median overall survival was 46.8 months in the C→E group and 38.9 months in the E→C group (p=0.151). Median composite progression-free survival (PFS), defined as the time from the start of the preceding regimen to disease progression on the following regimen or death, was 24.8 months in the C→E group vs. 21.8 months in the E→C group (p=0.681). Median PFS2/PFS1 ratio did not differ significantly between groups (0.5 in the C→E group, 0.6 in the E→C group; p=0.775). Ten patients (11.4%) discontinued EVE, and two patients (2.3%) discontinued CDK4/6i during treatment. Conclusion Although the CDK4/6i-based regimen should be considered as an earlier line of treatment, CDK4/6i- and EVE-based treatments can be valid options in circumstances where the other treatment had been already given.
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Affiliation(s)
- Hyehyun Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hee Ahn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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5
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Harbeck N, Bartlett M, Spurden D, Hooper B, Zhan L, Rosta E, Cameron C, Mitra D, Zhou A. CDK4/6 inhibitors in HR+/HER2- advanced/metastatic breast cancer: a systematic literature review of real-world evidence studies. Future Oncol 2021; 17:2107-2122. [DOI: 10.2217/fon-2020-1264] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: This review aims to qualitatively summarize the published real-world evidence (RWE) for CDK4/6 inhibitors (CDK4/6i) approved for treating HR+, HER2-negative advanced/metastatic breast cancer (HR+/HER2- a/mBC). Materials & methods: A systematic literature review was conducted to identify RWE studies of CDK4/6i in HR+/HER2- a/mBC published from 2015 to 2019. Results: This review identified 114 studies, of which 85 were only presented at scientific conferences. Most RWE studies investigated palbociclib and demonstrated improved outcomes. There are limited long-term and comparative data between CDK4/6i and endocrine monotherapy, and within the CDK4/6i class. Conclusion: Available RWE suggests that CDK4/6i are associated with improved outcomes in HR+/HER2- a/mBC, although additional studies with longer follow-up periods are needed.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Gynecology & Obstetrics & Comprehensive Cancer Center, LMU University Hospital, Munich, 81377, Germany
| | | | | | - Becky Hooper
- CRG-EVERSANA Canada, Inc., Burlington, ON L7N 3H8, Canada
| | | | - Emily Rosta
- CRG-EVERSANA Canada, Inc., Burlington, ON L7N 3H8, Canada
| | - Chris Cameron
- CRG-EVERSANA Canada, Inc., Burlington, ON L7N 3H8, Canada
| | | | - Anna Zhou
- CRG-EVERSANA Canada, Inc., Burlington, ON L7N 3H8, Canada
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Nakano S, Imawari Y, Mibu A, Kato S, Yamaguchi S, Otsuka M, Sano M. Use of molecular targeted therapy for hormone receptor-positive, human epidermal growth factor 2-negative metastatic breast cancer in real-world clinical practice. J NIPPON MED SCH 2021; 89:88-94. [PMID: 33867426 DOI: 10.1272/jnms.jnms.2022_89-203] [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: 11/19/2022]
Abstract
BACKGROUND The emergence of molecular targeted therapies (MTTs) has altered the treatment landscape of hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) metastatic breast cancer (MBC). The objective of this study was to describe treatment patterns, clinical outcomes, and safety profiles among patients with HR+/HER2- MBC treated with palbociclib, abemaciclib, or everolimus in a clinical practice setting. METHODS Forty-five patients with HR+/HER2- MBC were enrolled; of these, 40 received molecular targeted therapy (MTT) in ≥3rd lines and 5 received treatment in the 1st/2nd line. The results were compared with clinical trials. RESULTS Median progression-free survival (PFS) in all patients was 5.3 months (95% confidence interval [CI] 2.8-8.4), and a similar PFS was found for patients receiving 1st/2nd line (5.5 months, 95% CI 1.8- ) and ≥ 3rd line (5.1 months, 95% CI 2.8-9.4) treatments. Eleven patients continued with the same regimen for >1 year; treatment is ongoing for 15 patients. In 23 patients (51%), everolimus was administered prior to cyclin-dependent kinase (CDK) 4/6 inhibitors. The most frequent grade 3 or higher adverse event (AE) with CDK4/6 inhibitors was neutropenia, whereas AEs ≥ grade 3 with everolimus included Pneumocystis pneumonia, sepsis, and stomatitis. CONCLUSIONS Molecular targeted therapy (MTT) was mostly used in ≥ 3rd lines, and PFS of patients receiving 1st/2nd line and ≥ 3rd line treatments was similar; however, this study included heavily treated patients and a limited number of cases. Treatment options should take into consideration the maximal benefit to the patient based on the results of clinical trials.
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Affiliation(s)
- Satoko Nakano
- Department of Breast Surgery, Kawaguchi Municipal Medical Center
| | - Yoshimi Imawari
- Department of Breast Surgery, Kawaguchi Municipal Medical Center
| | - Akemi Mibu
- Department of Breast Surgery, Kawaguchi Municipal Medical Center
| | - Shunsuke Kato
- Department of Breast Surgery, Kawaguchi Municipal Medical Center.,Medical Oncology Department, Juntendo University
| | - Shigeo Yamaguchi
- Department of Breast Surgery, Kawaguchi Municipal Medical Center.,Surgical Department, Keio University School of Medicine
| | | | - Masataka Sano
- Department of Management, Chiba Institute of Technology
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7
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Palumbo R, Torrisi R, Sottotetti F, Presti D, Rita Gambaro A, Collovà E, Ferzi A, Agostinetto E, Maria Teragni C, Saltalamacchia G, Tagliaferri B, Balletti E, Bernardo A, Quaquarini E. Patterns of treatment and outcome of palbociclib plus endocrine therapy in hormone receptor-positive/HER2 receptor-negative metastatic breast cancer: a real-world multicentre Italian study. Ther Adv Med Oncol 2021; 13:1758835920987651. [PMID: 33796150 PMCID: PMC7970542 DOI: 10.1177/1758835920987651] [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: 07/06/2020] [Accepted: 12/11/2020] [Indexed: 12/09/2022] Open
Abstract
Background The CDK4/6 inhibitor palbociclib combined with endocrine therapy (ET) has proven to prolong progression-free survival (PFS) in women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). Few data are available regarding the efficacy of such a regimen outside the clinical trials. Patients and methods This is a multicentre prospective real-world experience aimed at verifying the outcome of palbociclib plus ET in an unselected population of MBC patients. The primary aim was the clinical benefit rate (CBR); secondary aims were the median PFS, overall survival (OS) and safety. Patients received palbociclib plus letrozole 2.5 mg (cohort A) or fulvestrant 500 mg (cohort B). Results In total, 191 patients (92 in cohort A, 99 in cohort B) were enrolled and treated, and 182 were evaluable for the analysis. Median age was 62 years (range 47-79); 54% had visceral involvement; 28% of patients had previously performed one treatment line (including chemotherapy and ET), 22.6% two lines and 15.9% three. An overall response rate of 34.6% was observed with 11 (6.0%) complete responses and 52 (28.6%) partial responses. Stable disease was achieved by 78 patients (42.9%) with an overall CBR of 59.8%. At a median follow-up of 24 months (range 6-32), median PFS was 13 months without significant differences between the cohorts. When analysed according to treatment line, PFS values were significantly prolonged when palbociclib-based therapy was administered as first-line treatment (14.0 months), to decrease progressively in second and subsequent lines (11.7 and 6.7 months, respectively). Median OS was 25 months, ranging from 28.0 months in 1st line to 18.0 and 13.0 months in 2nd and subsequent lines, respectively. Conclusions Our data indicate that palbociclib plus ET is active and safe in HR+/HER2- MBC, also suggesting a better performance of the combinations in earlier treatment lines.
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Affiliation(s)
| | - Rosalba Torrisi
- Department of Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | | | | | - Anna Rita Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco PO Sacco, Milano, Italy
| | - Elena Collovà
- Medical Oncology, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italy
| | - Antonella Ferzi
- Medical Oncology, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italy
| | - Elisa Agostinetto
- Department of Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | | | | | | | | | | | - Erica Quaquarini
- Medical Oncology Unit, IRCCS ICS Maugeri, Via Maugeri 10, Pavia, 27100, Italy
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8
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Onesti CE, Jerusalem G. CDK4/6 inhibitors in breast cancer: differences in toxicity profiles and impact on agent choice. A systematic review and meta-analysis. Expert Rev Anticancer Ther 2020; 21:283-298. [PMID: 33233970 DOI: 10.1080/14737140.2021.1852934] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: CDK4/6 inhibitor approval for hormone-responsive breast tumors has significantly changed therapeutic algorithms, with three drugs currently approved.Areas covered: Here, we analyze the toxicity profiles of palbociclib, ribociclib, and abemaciclib through a systematic review and meta-analysis. Palbociclib and ribociclib showed high rates of hematological toxicity, primarily neutropenia, and were associated with a low rate of severe infections. Abemaciclib was associated with a high rate of gastrointestinal toxicities, primarily diarrhea, of grade 1-2 in most cases. Ribociclib was associated with a high rate of hepatic, and respiratory toxicity and with QTc prolongation. The toxicity rate of ribociclib was higher in metastatic patients than non-metastatic patients, with approximately 33% more grade 3-4 toxicities and 21% more grade 3-4 neutropenic events. A 5% higher risk of diarrhea was observed in postmenopausal patients. Pre-treated patients did not show a higher toxicity rate for palbociclib/ribociclib than previously untreated patients, while a 26% higher risk of any grade neutropenia and 6% higher risk of grade 3-4 diarrhea were observed with abemaciclib.Expert opinion: Considering the similar efficacies and indications of palbociclib, ribociclib, and abemaciclib, the evaluation of their toxicity profiles may facilitate treatment choice.
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Affiliation(s)
- Concetta E Onesti
- Medical Oncology Department, CHU Liège Sart Tilman and Liège University, Liège, Belgium.,Laboratory of Human Genetics, GIGA Research Center, Liège, Belgium
| | - Guy Jerusalem
- Medical Oncology Department, CHU Liège Sart Tilman and Liège University, Liège, Belgium
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Porte B, Carton M, Lerebours F, Brain E, Loirat D, Haroun L, Bellesoeur A, Bach Hamba S, Kirova Y, Cottu P. Real life efficacy of palbociclib and endocrine therapy in HR positive, HER2 negative advanced breast cancer. Breast 2020; 54:303-310. [PMID: 33242757 PMCID: PMC7695984 DOI: 10.1016/j.breast.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Palbociclib is indicated for the treatment of hormone receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer (ABC), in combination with endocrine therapy. Emerging real-life data suggest that the efficacy of a palbociclib-based therapy is highly conserved. We report the Institut Curie hospital experience. PATIENTS AND METHODS We retrospectively reviewed all patients with HR + HER2- ABC treated with a palbociclib-based therapy as first or second line for ABC, with an initial prescription from November 2016 to December 2018. Clinical, laboratory and imaging data were retrieved from electronic records. Data lock was December 31st, 2019. Descriptive analyses, univariate and multivariate Cox regression analyses were performed. RESULTS We included 310 consecutive patients. Median age was 61.8 years old. Palbociclib was prescribed in first line in 225 patients (72.6%). Before palbociclib-based therapy initiation, 122 patients (39.3%) were endocrine naive, 96 (31.0%) endocrine sensitive and 92 (29.7%) endocrine resistant. Median follow-up was 20.7 months. Median progression free survival (PFS) was 23.4 months (95%CI: 21.6-NR) in endocrine naive patients, 22.7 months (95%CI: 14.7-NR) in endocrine sensitive, and 13.4 months (95%CI: 10.7-20.8) in endocrine resistant. At 12 months from the initiation of palbociclib, 94.5% of patients were alive. By multivariate analysis, poor prognosis factors for PFS were identified in the endocrine naive/sensitive population: initial ECOG status 2, previous endocrine therapy for ABC, 3 metastatic sites or more. Toxicity profile was similar to previously published data. CONCLUSION In a non-selected population of patients with HR + HER2- ABC, the efficacy and safety data are strikingly similar to those previously reported.
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Affiliation(s)
- B Porte
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - M Carton
- Department of Biostatistics, Institut Curie, Paris and Saint Cloud, France
| | - F Lerebours
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - E Brain
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - D Loirat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - L Haroun
- Department of Data, Institut Curie, Paris and Saint Cloud, France
| | - A Bellesoeur
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - S Bach Hamba
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Y Kirova
- Department of Radiation Oncology, Institut Curie, Paris and Saint Cloud, France
| | - P Cottu
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.
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10
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Palbociclib combined with endocrine therapy in heavily pretreated HR +/HER2 - advanced breast cancer patients: Results from the compassionate use program in Spain (PALBOCOMP). Breast 2020; 54:286-292. [PMID: 33242755 PMCID: PMC7695980 DOI: 10.1016/j.breast.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/22/2023] Open
Abstract
Background This study evaluated efficacy and safety of palbociclib, a CDK4/6 inhibitor, in heavily-pretreated hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) patients during the compassionate use program in Spain from February 2015 to November 2017. Patients and methods Patient data were collected retrospectively from 35 hospitals in Spain. Patients with HR+/HER2- mBC who had progressed on ≥4 treatments for advanced disease were eligible. Results A total of 219 patients received palbociclib in combination with aromatase inhibitors (110; 50.2%), fulvestrant (87; 39.7%), tamoxifen (8; 3.6%) or as single agent (10; 4.6%). Mean age of the patients was 58 years; 31 patients (16.1%) were premenopausal and 162 (83.9%) were postmenopausal at the beginning of treatment with palbociclib. Patients had received a median of 3 previous lines of endocrine therapy (ET) for advanced disease. Real-world tumor response (rwTR) and clinical benefit rate were 5.9% (n = 13) and 46.2% (n = 101), respectively. The median real world progression-free survival (rwPFS) was 6.0 months (95% CI 5.7–7.0) and the median overall survival was 19.0 months (95% CI 16.4–21.7). Subgroup analysis revealed a significant difference in median rwPFS in patients treated with palbociclib plus fulvestrant depending on the duration of prior treatment with fulvestrant monotherapy (>6 versus ≤6 months; HR 1.93, 95% CI 1.37–2.73, p < 0.001). The most frequently reported toxicities were neutropenia, asthenia, thrombopenia and anemia. Conclusions Palbociclib can be an effective and safe treatment option in patients with heavily pretreated endocrine-sensitive mBC, especially in those with longer PFS to previous ET. CDK4/6 inhibitors combined with endocrine therapy have been widely accepted as a new standard therapy for hormone receptor-positive metastatic breast cancer patients in first or second line. Palbociclib alone or in combination with aromatase inhibitors, fulvestrant, or tamoxifen was effective and safe in heavily pretreated HR+/HER2- metastatic breast cancer patients. Palbociclib could be of higher benefit to patients with endocrine-sensitive disease that had a long duration of response to previous endocrine therapy. Real-world evidence of effectiveness and safety of use of palbociclib in heavily pretreated advanced breast cancer patients complements data from randomized clinical trials.
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11
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O'Brien NA, McDermott MSJ, Conklin D, Luo T, Ayala R, Salgar S, Chau K, DiTomaso E, Babbar N, Su F, Gaither A, Hurvitz SA, Linnartz R, Rose K, Hirawat S, Slamon DJ. Targeting activated PI3K/mTOR signaling overcomes acquired resistance to CDK4/6-based therapies in preclinical models of hormone receptor-positive breast cancer. Breast Cancer Res 2020; 22:89. [PMID: 32795346 PMCID: PMC7427086 DOI: 10.1186/s13058-020-01320-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/23/2020] [Indexed: 01/05/2023] Open
Abstract
Background Combined targeting of CDK4/6 and ER is now the standard of care for patients with advanced ER+/HER2− breast cancer. However, acquired resistance to these therapies frequently leads to disease progression. As such, it is critical to identify the mechanisms by which resistance to CDK4/6-based therapies is acquired and also identify therapeutic strategies to overcome resistance. Methods In this study, we developed and characterized multiple in vitro and in vivo models of acquired resistance to CDK4/6-based therapies. Resistant models were screened by reverse phase protein array (RPPA) for cell signaling changes that are activated in resistance. Results We show that either a direct loss of Rb or loss of dependence on Rb signaling confers cross-resistance to inhibitors of CDK4/6, while PI3K/mTOR signaling remains activated. Treatment with the p110α-selective PI3K inhibitor, alpelisib (BYL719), completely blocked the progression of acquired CDK4/6 inhibitor-resistant xenografts in the absence of continued CDK4/6 inhibitor treatment in models of both PIK3CA mutant and wild-type ER+/HER2− breast cancer. Triple combination therapy against PI3K:CDK4/6:ER prevented and/or delayed the onset of resistance in treatment-naive ER+/HER2− breast cancer models. Conclusions These data support the clinical investigation of p110α-selective inhibitors of PI3K, such as alpelisib, in patients with ER+/HER2− breast cancer who have progressed on CDK4/6:ER-based therapies. Our data also support the investigation of PI3K:CDK4/6:ER triple combination therapy to prevent the onset of resistance to the combination of endocrine therapy plus CDK4/6 inhibition.
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Affiliation(s)
- Neil A O'Brien
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Martina S J McDermott
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dylan Conklin
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tong Luo
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Raul Ayala
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Suruchi Salgar
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kevin Chau
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emmanuelle DiTomaso
- Novartis Pharmaceuticals, Cambridge, MA, USA.,Currently Bayer Pharmaceuticals, Boston, MA, USA
| | | | - Faye Su
- Novartis Pharmaceuticals, Cambridge, MA, USA
| | - Alex Gaither
- Novartis Pharmaceuticals, Cambridge, MA, USA.,Currently LG Life Sciences, Cambridge, MA, USA
| | - Sara A Hurvitz
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | - Samit Hirawat
- Novartis Pharmaceuticals, Cambridge, MA, USA.,Currently Bristol Myers Squibb, Lawrenceville, NJ, USA
| | - Dennis J Slamon
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,UCLA Translational Oncology, 2825 Santa Monica Blvd, Suite 200, Santa Monica, CA, 90404, USA.
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12
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Nakayama T, Fujisawa F. Therapy options after CDK4/6 inhibitors for HR+, HER2- postmenopausal metastatic/recurrent breast cancer in Japan: a role for mammalian target of rapamycin inhibitors? Future Oncol 2020; 16:1851-1862. [PMID: 32614252 DOI: 10.2217/fon-2020-0326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite advances in the treatment of hormone receptor-positive, HER2- metastatic breast cancer, the disease is rarely curable. In this review, we focus on the use of CDK4/6 inhibitors, examining clinical experience and the mechanisms underlying the development of resistance, and evaluating treatment options after failure to respond to CDK4/6 inhibitors. Current basic research supports the use of mammalian target of rapamycin inhibitors after CDK4/6 inhibitor failure; however, more data are needed, particularly regarding treatment sequencing. Real-world data studies may help to fill the current knowledge gap, particularly where large-scale randomized controlled studies are not feasible.
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Affiliation(s)
- Takahiro Nakayama
- Breast & Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Fumie Fujisawa
- Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
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13
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Herrscher H, Velten M, Leblanc J, Kalish-Weindling M, Fischbach C, Exinger D, Pivot X, Petit T. Fulvestrant and palbociclib combination in heavily pretreated hormone receptor-positive, HER2-negative metastatic breast cancer patients. Breast Cancer Res Treat 2020; 179:371-376. [PMID: 31612291 DOI: 10.1007/s10549-019-05439-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/06/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE We report the results of a retrospective analysis of the fulvestrant and palbociclib combination within a temporary authorization of use (TAU) program in 77 heavily pretreated patients with hormone receptor-positive (HR+), HER2-negative metastatic breast cancer. METHODS All patients who received the fulvestrant and palbociclib combination within this TAU program were included. Toxicities were graded using the CTCAE v5 scale. RESULTS The majority of patients (62.3%) were previously treated with the mTOR inhibitor everolimus. The median number of previous treatments for their metastatic disease was 4. With a median follow-up of 14 months, the median progression-free survival (PFS) was 7.6 months. The median PFS significantly (p < 0.0001) decreased with the number of previous treatment lines in the metastatic setting. The median PFS was 5.5 months in patients who had previously progressed on everolimus compared to 9.3 months in the everolimus non-pretreated subgroup. No significant difference in median PFS was detected in patients according to age. The median overall survival rate was not reached. The clinical benefit rate was 64%, including 4% of complete responses, 26% partial responses, and 34% stable diseases for the entire cohort. CONCLUSIONS The fulvestrant and palbociclib combination exerts an appreciable effect on metastatic heavily pretreated patients with a tolerable toxicity profile.
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Affiliation(s)
- Hugo Herrscher
- Department of Medical Oncology, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, Cedex, France
| | - Michel Velten
- Department of Epidemiology, Centre Paul Strauss, Strasbourg, France
| | - Julie Leblanc
- Department of Medical Oncology, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, Cedex, France
| | - Michal Kalish-Weindling
- Department of Medical Oncology, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, Cedex, France
| | - Cathie Fischbach
- Department of Medical Oncology, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, Cedex, France
| | | | - Xavier Pivot
- Department of Medical Oncology, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, Cedex, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 30042, 67065, Strasbourg, Cedex, France.
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14
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Challenges and future of precision medicine strategies for breast cancer based on a database on drug reactions. Biosci Rep 2019; 39:BSR20190230. [PMID: 31387972 PMCID: PMC6732363 DOI: 10.1042/bsr20190230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/02/2019] [Accepted: 07/15/2019] [Indexed: 01/12/2023] Open
Abstract
Breast cancer (BC) is a malignancy with the highest incidence in women. Great progress has been made in research related to traditional precision medicine for BC. However, many reports have suggested that patients with BC have not benefited a lot from such progress. Thus, we analyze traditional precision medicine strategies for BC, sum up their limitations and challenges, and preliminarily propose future orientations of precision medicine strategies based on a database on drug reaction of patients with BC. According to related research, traditional precision medicine strategies for BC, which are based on molecular subtypes, perform pertinent treatments, new drug research and development according to molecular typing results. Nevertheless, these strategies still have some deficiencies. First, there are very few patients with each molecular subtype, the match ratio of drugs is low. Second, these strategies can not solve the problem of poor drug sensitivity resulting from heterogeneity. The main strategy we put forward in the present paper is based on patients’ varying drug reactions. Focusing on treating existing patients and maximizing the utilization of existing drugs, it is expected to not have deficiencies of traditional precision medicine for BC, including low match rate and poor therapeutic efficacy arising from tumor heterogeneity of BC.
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15
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Serra F, Lapidari P, Quaquarini E, Tagliaferri B, Sottotetti F, Palumbo R. Palbociclib in metastatic breast cancer: current evidence and real-life data. Drugs Context 2019; 8:212579. [PMID: 31391852 PMCID: PMC6668507 DOI: 10.7573/dic.212579] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/25/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of this review is to summarize the background and latest evidence for the use of palbociclib, an oral, first-in-class, highly selective cyclin-dependent kinase 4/6 inhibitor, in advanced breast cancer, with a focus on some of the unanswered questions about the performance of this agent in clinical practice. The available clinical data from both controlled clinical trials and real-life experiences concerning palbociclib-based combinations in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic disease, including patient-reported outcomes and subgroup analyses, have been reviewed and discussed. Palbociclib significantly improved progression-free survival and clinical benefit rates when added to letrozole in postmenopausal women as initial endocrine-based therapy, and it prolonged progression-free survival and overall survival when added to fulvestrant in women who progressed on previous endocrine therapy in randomized clinical trials. Tolerability profile was manageable, with neutropenia occurring most commonly, without detrimental impact on quality of life. Available data from real-life experiences confirm the good performance of palbociclib in unselected, heavily pretreated populations. Palbociclib in combination with endocrine therapy is a valuable emerging option for patients with HR+/HER2- advanced or metastatic breast cancer. Further investigation is needed to provide solutions for palbociclib resistance and to identify the best sequence to use for the best patient benefit with a minimal toxicity.
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Affiliation(s)
- Francesco Serra
- Operative Unit of Medical Oncology IRCCS-ICS Maugeri, Pavia, Italy
| | - Pietro Lapidari
- Operative Unit of Medical Oncology IRCCS-ICS Maugeri, Pavia, Italy
| | - Erica Quaquarini
- Operative Unit of Medical Oncology IRCCS-ICS Maugeri, Pavia, Italy.,PhD in Experimental Medicine, University of Pavia, Pavia, Italy
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16
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Abstract
Deregulated cell division, resulting in aberrant cell proliferation, is one of the key hallmarks of cancer. Cyclin-dependent kinases (CDKs) play a central role in cell cycle progression in cancer, and the clinical development of the CDK4/6 inhibitors palbociclib, ribociclib, and abemaciclib has changed clinical practice in the setting of endocrine-receptor positive breast cancer. Results of pivotal phase II and III trials investigating these CDK4/6 inhibitors in patients with endocrine receptor-positive, advanced breast cancer have demonstrated a significant improvement in progression-free survival, with a safe toxicity profile. No validated biomarkers of sensitivity or resistance exist at the moment. Future development of CDK4/6 inhibitors in breast cancer should focus on the identification of predictive biomarkers, the development of drug combinations to overcome resistance, and the application of CDK4/6 inhibitors to other breast cancer subtypes.
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17
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Pizzuti L, Giordano A, Michelotti A, Mazzotta M, Natoli C, Gamucci T, De Angelis C, Landucci E, Diodati L, Iezzi L, Mentuccia L, Fabbri A, Barba M, Sanguineti G, Marchetti P, Tomao S, Mariani L, Paris I, Lorusso V, Vallarelli S, Cassano A, Aroldi F, Orlandi A, Moscetti L, Sergi D, Sarobba MG, Tonini G, Santini D, Sini V, Veltri E, Vaccaro A, Ferrari L, De Tursi M, Tinari N, Grassadonia A, Greco F, Botticelli A, La Verde N, Zamagni C, Rubino D, Cortesi E, Magri V, Pomati G, Scagnoli S, Capomolla E, Kayal R, Scinto AF, Corsi D, Cazzaniga M, Laudadio L, Forciniti S, Mancini M, Carbognin L, Seminara P, Barni S, Samaritani R, Roselli M, Portarena I, Russo A, Ficorella C, Cannita K, Carpano S, Pistelli M, Berardi R, De Maria R, Sperduti I, Ciliberto G, Vici P. Palbociclib plus endocrine therapy in HER2 negative, hormonal receptor-positive, advanced breast cancer: A real-world experience. J Cell Physiol 2019; 234:7708-7717. [PMID: 30536609 DOI: 10.1002/jcp.27832] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
Data from 423 human epidermal growth factor receptor 2-negative (HER2-), hormone receptor-positive (HR+) advanced breast cancer (aBC) patients treated with palbociclib and endocrine therapy (ET) were provided by 35 Italian cancer centers and analyzed for treatment outcomes. Overall, 158 patients were treated in first line and 265 in second/later lines. We observed 19 complete responses and 112 partial responses. The overall response rate (ORR) was 31% (95% confidence interval [CI], 26.6-35.4) and clinical benefit was 52.7% (95% CI, 48-57.5). ORR was negatively affected by prior exposure to everolimus/exemestane ( p = 0.002) and favorably influenced by early line-treatment ( p < 0.0001). At 6 months, median progression-free survival was 12 months (95% CI, 8-16) and median overall survival was 24 months (95% CI, 17-30). More favorable outcomes were associated with palbociclib in early lines, no visceral metastases and no prior everolimus/exemestane. The main toxicity reported was neutropenia. Our results provide further support to the use of palbociclib with ET in HER2-, HR+ aBC. Differences in outcomes across patients subsets remain largely unexplained.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Marco Mazzotta
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Clara Natoli
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, SS Trinità Hospital, Sora, Italy
- Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Claudia De Angelis
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elisabetta Landucci
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lucrezia Diodati
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Laura Iezzi
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | | | - Agnese Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
- Department of Clinical and Molecular Medicine, A Oncology Division, "Sapienza" University of Rome, Rome, Italy
| | - Silverio Tomao
- Department of Clinical and Molecular Medicine, A Oncology Division, La "Sapienza" University of Rome, Rome, Italy
| | - Luciano Mariani
- HPV Unit, Department of Gynaecologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ida Paris
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Lorusso
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Simona Vallarelli
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Francesca Aroldi
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Armando Orlandi
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Valentina Sini
- Oncology Unit, ASL Roma 1, Santo Spirito Hospital, Rome, Italy
| | - Enzo Veltri
- Division of Medical Oncology, Ospedale S. Maria Goretti, Latina, Italy
| | - Angela Vaccaro
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Laura Ferrari
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Filippo Greco
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Department of Oncology, Milan, Italy
| | - Andrea Botticelli
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Nicla La Verde
- Department of Oncology, ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, Italy
| | - Claudio Zamagni
- SSD Oncologia Medica "Addarii", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Daniela Rubino
- SSD Oncologia Medica "Addarii", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Enrico Cortesi
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Valentina Magri
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Giulia Pomati
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Simone Scagnoli
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | | | - Ramy Kayal
- Department of Radiology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Domenico Corsi
- Medical Oncology Unit, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | | | | | | | - Maria Mancini
- Medical Oncology, Ospedale F. Renzetti, Lanciano, Italy
| | - Luisa Carbognin
- Department of Pathology, Surgery and Oncology, "Mater Salutis" Hospital, ULSS21, Verona, Italy
| | - Patrizia Seminara
- Department of Clinical and Molecular Medicine, A Oncology Division, "Sapienza" University of Rome, Rome, Italy
| | - Sandro Barni
- Department of Oncology, Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Rome, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Corrado Ficorella
- Medical Oncology Department, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology Department, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mirco Pistelli
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Isabella Sperduti
- Bio-statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Bui TBV, Burgers DM, Agterof MJ, van de Garde EM. Real-World Effectiveness of Palbociclib Versus Clinical Trial Results in Patients With Advanced/Metastatic Breast Cancer That Progressed on Previous Endocrine Therapy. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2019; 13:1178223418823238. [PMID: 30675102 PMCID: PMC6330732 DOI: 10.1177/1178223418823238] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/09/2018] [Indexed: 11/23/2022]
Abstract
Objective: The aim of this study was to assess the real-world effectiveness and
tolerability of palbociclib combined with endocrine therapy for the
treatment of hormone receptor positive (HR-positive), human epidermal growth
factor receptor 2 negative (HER2-negative), advanced/metastatic breast
cancer that progressed on previous endocrine therapy, and to compare these
results with the outcomes of the PALOMA-3 clinical trial. Methods: This study was a retrospective observational cohort study including all
patients who started with palbociclib in the St. Antonius Hospital between
September 1, 2016 and April 1, 2018 for the treatment of HR-positive,
HER2-negative advanced/metastatic breast cancer that progressed on previous
endocrine therapy. Individual patient data were collected from electronic
medical records. Primary study outcomes were progression-free survival (PFS)
and the number of permanent treatment discontinuations before disease
progression due to adverse events (AEs). Secondary outcomes were the
frequency of all (serious) AEs and the frequency of and reasons for dose
reductions, -interruptions and cycle delays. Results: A total of 46 patients were studied with a median follow-up of 13.0 months.
Overall, the median PFS in real-world clinical practice was 10.0 months (95%
confidence interval (CI) 4.9-15.1), compared with 9.5 months in PALOMA-3
(95% CI 9.2-11.0). Two patients discontinued treatment because of AEs.
Neutropenia was the most frequent grade 3-4 AE, but with no febrile
neutropenia events. Most AEs were managed with palbociclib dose
modifications. Regarding these modifications, more cycle delays, less dose
reductions, and less dose interruptions occurred in clinical practice
compared with PALOMA-3 (59 vs 36%, 22 vs 34%, and 9 vs 54%, respectively).
Patients who did not meet the PALOMA-3 study eligibility criteria (n = 16)
showed a lower median PFS of 5.5 months (95% CI 4.7-6.4). Conclusions: The effectiveness and tolerability of palbociclib in real-world clinical
practice corresponded well with the results obtained in the PALOMA-3
clinical trial. Despite the differences in dose modifications, this study
suggests that there is no efficacy-effectiveness gap in this patient
population.
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Affiliation(s)
- Tam Binh V Bui
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Desirée Mt Burgers
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Mariette J Agterof
- Department of Internal Medicine, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Ewoudt Mw 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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19
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Portman N, Alexandrou S, Carson E, Wang S, Lim E, Caldon CE. Overcoming CDK4/6 inhibitor resistance in ER-positive breast cancer. Endocr Relat Cancer 2019; 26:R15-R30. [PMID: 30389903 DOI: 10.1530/erc-18-0317] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022]
Abstract
Three inhibitors of CDK4/6 kinases were recently FDA approved for use in combination with endocrine therapy, and they significantly increase the progression-free survival of patients with advanced estrogen receptor-positive (ER+) breast cancer in the first-line treatment setting. As the new standard of care in some countries, there is the clinical emergence of patients with breast cancer that is both CDK4/6 inhibitor and endocrine therapy resistant. The strategies to combat these cancers with resistance to multiple treatments are not yet defined and represent the next major clinical challenge in ER+ breast cancer. In this review, we discuss how the molecular landscape of endocrine therapy resistance may affect the response to CDK4/6 inhibitors, and how this intersects with biomarkers of intrinsic insensitivity. We identify the handful of pre-clinical models of acquired resistance to CDK4/6 inhibitors and discuss whether the molecular changes in these models are likely to be relevant or modified in the context of endocrine therapy resistance. Finally, we consider the crucial question of how some of these changes are potentially amenable to therapy.
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Affiliation(s)
- Neil Portman
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
| | - Sarah Alexandrou
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
| | - Emma Carson
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
| | - Shudong Wang
- Centre for Drug Discovery and Development, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Elgene Lim
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
| | - C Elizabeth Caldon
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
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Dhakal A, Matthews CM, Levine EG, Salerno KE, Zhang F, Takabe K, Early AP, Edge SB, O'Connor T, Khoury T, Young JS, Opyrchal M. Efficacy of Palbociclib Combinations in Hormone Receptor-Positive Metastatic Breast Cancer Patients After Prior Everolimus Treatment. Clin Breast Cancer 2018; 18:e1401-e1405. [PMID: 29778787 PMCID: PMC10913429 DOI: 10.1016/j.clbc.2018.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/19/2018] [Accepted: 04/21/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Outcome data on hormone receptor positive (HR+), human epidermal growth factor receptor 2 (HER2) nonamplified (HER2-) metastatic breast cancer (MBC) treated with palbociclib after treatment with everolimus are lacking. The PALOMA-3 trial, showing benefit of palbociclib plus fulvestrant compared to fulvestrant alone in HR+HER2- MBC after progression while receiving endocrine therapy excluded women previously treated with everolimus. The objective of this study was to examine outcomes of HR+HER2- MBC with prior exposure to everolimus while receiving palbociclib-based therapy. PATIENTS AND METHODS A retrospective, single-institute review was conducted of HR+HER2- MBC from January 2014 to November 2016 in patients treated with palbociclib after prior treatment with everolimus. Progression-free survival (PFS) was defined as the time from initiation of palbociclib to the date of progression as determined by the treating physician based on radiologic, biochemical, and/or clinical criteria. Response rates were determined on the basis of available radiologic data. Objective response rate (ORR) was defined as the rate of any complete or partial responses; clinical benefit rate (CBR) was the rate of complete response, partial response, or stable disease for at least 24 weeks. RESULTS Twenty-three patients with a mean (range) age of 68 (42-81) years were identified. Kaplan-Meier estimate showed median PFS of 2.9 months (95% confidence interval, 2.1-4.2); ORR was 0 of 23 and CBR was 4 (17.4%) of 23. In the PALOMA-3 trial, median PFS, ORR, and CBR of palbociclib cohort were 9.5 months (95% confidence interval, 9.2-11.0), 19%, and 67%, respectively. CONCLUSION There is a limited clinical activity of palbociclib combinations after progression with everolimus combination therapy. Further studies are necessary to confirm these findings.
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Affiliation(s)
- Ajay Dhakal
- Deparmtent of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY.
| | | | - Ellis Glenn Levine
- Deparmtent of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Fan Zhang
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Amy P Early
- Deparmtent of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Stephen B Edge
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Tracy O'Connor
- Deparmtent of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Jessica S Young
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Mateusz Opyrchal
- Deparmtent of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Palbociclib to reverse endocrine resistance in breast cancer: a TREnd in the right direction? Oncotarget 2018; 9:34031-34032. [PMID: 30344918 PMCID: PMC6183349 DOI: 10.18632/oncotarget.26133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022] Open
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