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Parsonson AO, Sarkar S, Brown L, Low GKK, Kiely BE, Vasista A. Beyond the median: Estimating survival times for patients starting endocrine therapy for estrogen receptor-positive, metastatic breast cancer from recent randomized trials. Asia Pac J Clin Oncol 2024. [PMID: 38881159 DOI: 10.1111/ajco.14096] [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: 09/18/2023] [Revised: 04/19/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024]
Abstract
AIM To estimate scenarios for survival for patients with estrogen receptor (ER) positive, metastatic breast cancer (MBC) and to help communicate prognosis to patients starting endocrine therapy (ET) METHODS: We searched for randomized trials of ET for ER-positive MBC and extracted the following percentiles (representative survival scenarios) from each overall survival (OS) curve: 90th (worst-case), 75th (lower-typical), 50th (median), 25th (upper-typical), and 10th (best-case). We then assessed the accuracy of estimating these percentiles for each OS curve by multiplying the median OS by four simple multiples: 0.25 (to estimate the 90th percentile), 0.5 (75th), 2 (25th), and 3 (10th). Estimates were deemed accurate if it fell within 0.75-1.33 times the actual value. RESULTS We identified 25 trials with 10,566 patients. The median OS (interquartile range) was: 61.3 months (53.4-64.8) for first-line ET with cyclin-dependant kinase 4/6 inhibitors (four treatment groups); 42.6 months (40.9-50.4) for first-line ET alone (21 treatment groups) and 29.2 months (24.8-33.4) for subsequent line ET (19 treatment groups). Simple multiples of the median OS accurately estimated the 90th percentile in 80%; 75th percentile in 93%; and 25th percentile in 76% of curves. The 10th percentile was only available for four OS curves and could not be evaluated. CONCLUSION Simple multiples of the median OS are a helpful and accurate method to assist in estimating and discussing scenarios for survival for MBC patients starting ET. Longer follow-up of trials is required to help clinicians estimate the best-case scenario.
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Affiliation(s)
- Andrew O Parsonson
- Nepean Cancer and Wellness Centre, Nepean Hospital, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Sunit Sarkar
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, Australia
| | - Lauren Brown
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia
| | - Gary K K Low
- Research Operations, Nepean Hospital, Sydney, Australia
| | - Belinda E Kiely
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia
| | - Anuradha Vasista
- Nepean Cancer and Wellness Centre, Nepean Hospital, Sydney, Australia
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2
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Rugo HS, Liu X, Li B, McRoy L, Chen C, Layman RM, Brufsky A. Real-world treatment patterns for palbociclib plus an aromatase inhibitor, or an aromatase inhibitor alone, for patients with metastatic breast cancer in the Flatiron Database. Int J Cancer 2024; 154:701-711. [PMID: 37831416 DOI: 10.1002/ijc.34748] [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: 06/02/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023]
Abstract
There are limited real-world comparative effectiveness data for palbociclib plus an aromatase inhibitor (AI) as a first-line (1L) treatment examining endpoints that require long term follow-up and post 1L progression. The Flatiron Health Analytic Database was used to characterize treatment and dosing patterns in patients with hormone receptor-positive/human epidermal growth factor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) receiving palbociclib plus an AI vs an AI alone in routine US clinical practice. In addition, time to chemotherapy (TTC) and real-world progression-free survival (rwPFS) when combining 1L and second-line of therapy (rwPFS2) were assessed. Of 1324 patients who received palbociclib plus an AI between February 3, 2015 and March 31, 2020, 1110 (83.8%) started palbociclib at the recommended 125 mg/day dose. After stabilized inverse probability treatment-weighting (sIPTW), median TTC in patients treated with palbociclib plus an AI and AI alone was 37.4 months (95% confidence interval [CI], 33.7-40.7) and 29.2 months (95% CI, 26.8-33.5), respectively (hazard ratio [HR] = 0.77 [95% CI, 0.69-0.86], P < .0001); median rwPFS2 was 32.6 months (95% CI, 29.4-35.2) and 20.7 months (95% CI, 18.9-22.6), respectively (HR = 0.62 [95% CI, 0.54-0.70], P < .0001). Sensitivity analyses with propensity score matching showed similar results to sIPTW analyses. Results from this large real-world study examining additional effectiveness outcomes beyond 1L rwPFS and overall survival support the use of palbociclib plus an AI as a 1L treatment for patients with HR+/HER2- mBC.
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Affiliation(s)
- Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, California, USA
| | | | | | | | | | - Rachel M Layman
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adam Brufsky
- Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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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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Zhao M, Hanson KA, Zhang Y, Zhou A, Cha-Silva AS. Place in Therapy of Cyclin-Dependent Kinase 4/6 Inhibitors in Breast Cancer: A Targeted Literature Review. Target Oncol 2023; 18:327-358. [PMID: 37074594 DOI: 10.1007/s11523-023-00957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 04/20/2023]
Abstract
Cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) are the preferred regimen for patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced or metastatic breast cancer. However, the optimal treatment sequencing for CDK4/6i with other available therapeutic options is unclear. We conducted a targeted literature review to identify the current evidence on CDK4/6i treatment patterns in patients with breast cancer. The search was initially conducted in October 2021 and subsequently updated in October 2022. Biomedical databases and gray literature were searched, and bibliographies of included reviews were screened for relevant studies. The search identified ten reviews published since 2021 and 87 clinical trials or observational studies published since 2015. The included reviews discussed CDK4/6i usage with or without endocrine therapy (ET) in first-line and second-line treatment for patients with HR+/HER2- advanced or metastatic breast cancer, followed by ET, chemotherapy, or targeted therapy with ET. Clinical studies reported similar treatment sequences consisting of ET, chemotherapy, or targeted therapy with ET prior to CDK4/6i with ET, followed by ET monotherapy, chemotherapy, targeted therapy with ET, or continued CDK4/6i with ET. Current evidence suggests CDK4/6i are effective for HR+/HER2- advanced or metastatic breast cancer in earlier lines of therapy. Efficacy of CDK4/6i as measured by progression-free survival and overall survival was similar within a line of therapy regardless of the type of prior therapy. Survival on different post-CDK4/6i treatments was also similar within the same line of therapy. Additional research is needed to investigate the optimal place in therapy of CDK4/6i and the sequencing of treatments following progression on CDK4/6i.
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Affiliation(s)
- Melody Zhao
- EVERSANA, 113-3228 South Service Road, Burlington, ON, L9N 3H8, Canada.
| | | | - Yixie Zhang
- EVERSANA, 113-3228 South Service Road, Burlington, ON, L9N 3H8, Canada
| | - Anna Zhou
- EVERSANA, 113-3228 South Service Road, Burlington, ON, L9N 3H8, Canada
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Franks J, Caston NE, Elkhanany A, Gerke T, Azuero A, Rocque GB. Effect of prior treatments on post-CDK 4/6 inhibitor survival in hormone receptor-positive breast cancer. Breast Cancer Res Treat 2023; 197:673-681. [PMID: 36539670 PMCID: PMC9883320 DOI: 10.1007/s10549-022-06823-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Multiple treatment options exist for patients with metastatic breast cancer (MBC). However, limited information is available on the impact of prior treatment duration and class on survival outcome for novel therapies, such as cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) for patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+ HER2-) MBC. METHODS This study used a nationwide, de-identified electronic health record-derived database to identify women with HR+ HER2- MBC who received at least one CDK 4/6i between 2011 and 2020. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for the association between prior duration and class of cancer treatment (both early-stage and metastatic) and prior CDK 4/6i survival as well as for those with multiple CDK 4/6i. RESULTS Of 5363 patients, the median survival from first CDK 4/6 inhibitor administration was 3.3 years. When compared to patients with no prior treatments, patients with < 1 year of prior treatment duration had a 30% increased hazard of death (HR, 1.30; 95% CI 1.15-1.46), those with 1 to < 3 years a 68% increased hazard of death (HR 1.68; 95% CI 1.49-1.88), and those with 3 or more years a 55% increased hazard of death (HR 1.55; 95% CI 1.36, 1.76). Patients who received prior therapy (endocrine or chemotherapy) before their CDK 4/6i had worse outcomes than those who received no prior therapy. Similar results were seen when comparing patients in the metastatic setting alone. Finally, patients who received a different CDK 4/6i after their first saw a lower hazard of death compared to patients who received subsequent endocrine or chemotherapy after their first CDK 4/6i. CONCLUSION Prior treatment duration and class are associated with a decreased overall survival after CDK 4/6 inhibitor administration. This highlights the importance for clinicians to consider prior treatment and duration in treatment decision-making and for trialists to stratify by these factors when randomizing patients or reporting results of future studies.
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Affiliation(s)
- Jeffrey Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1808 7th Avenue South 35233 - Boshell Diabetes Building, Birmingham, AL, USA
| | - Nicole E Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1808 7th Avenue South 35233 - Boshell Diabetes Building, Birmingham, AL, USA
| | - Ahmed Elkhanany
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1808 7th Avenue South 35233 - Boshell Diabetes Building, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Travis Gerke
- The Prostate Cancer Clinical Trials Consortium, New York, NY, USA
| | - Andres Azuero
- O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle B Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1808 7th Avenue South 35233 - Boshell Diabetes Building, Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
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Palbociclib and letrozole in hormone-receptor positive advanced breast cancer: Predictive response and prognostic factors. Curr Probl Cancer 2022; 46:100859. [DOI: 10.1016/j.currproblcancer.2022.100859] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/03/2022] [Accepted: 03/06/2022] [Indexed: 12/22/2022]
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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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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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Zattarin E, Ligorio F, Nichetti F, Bianchi G, Capri G, de Braud F. Prolonged benefit from palbociclib plus letrozole in heavily pretreated advanced male breast cancer: case report. TUMORI JOURNAL 2020; 107:NP15-NP19. [PMID: 33297845 DOI: 10.1177/0300891620976981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Breast cancer in men is less common than in women and treatment recommendations are often derived from clinical trials exclusively involving women. Data on efficacy of CDK 4/6 inhibitors, which are the mainstay of treatment for hormone receptor-positive/HER2-negative advanced breast cancer, are lacking in male patients. CASE REPORT We present a clinical case of prolonged benefit from palbociclib in combination with letrozole and LHRH analogue in a man who had previously been treated with six lines of endocrine therapies and chemotherapy regimens but was still in excellent clinical condition. CONCLUSIONS This clinical case demonstrates that male breast cancer stands out as an endocrine-sensitive disease, which could potentially benefit from CDK 4/6 inhibitors in combination with endocrine agents even in very heavily pretreated settings of disease, underscoring both the importance of an accurate selection of patients for later treatment lines, taking into account disease history and previous treatment responses, and the peculiarity of breast cancer in men, which deserves dedicated clinical trials to tailor future recommendations.
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Affiliation(s)
- Emma Zattarin
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Francesca Ligorio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Giulia Bianchi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Giuseppe Capri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Italy
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Pailee P, Prawat H, Ploypradith P, Mahidol C, Ruchirawat S, Prachyawarakorn V. Atalantiaphyllines A-G, prenylated acridones from Atalantia monophylla DC. and their aromatase inhibition and cytotoxic activities. PHYTOCHEMISTRY 2020; 180:112525. [PMID: 33010534 DOI: 10.1016/j.phytochem.2020.112525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Seven previously undescribed acridones, named atalantiaphyllines A-G, along with twenty-six known compounds were isolated from the dichloromethane extracts of roots and stems of Atalantia monophylla DC. Their structures were elucidated by analysis of extensive NMR and HRMS data. Aromatase inhibition, cytotoxicity against MOLT-3, HepG2, A549 and HuCCA-1 cell lines and DPPH radical scavenging activity of these compounds were evaluated. Most of the tested acridones exhibited higher potency in inhibiting aromatase than the positive control, ketoconazole, with IC50 values in the range of 0.08-2.0 μM. In the cytotoxicity assay, cycloataphylline A, N-methylbuxifoliadine E and atalantiaphylline G were selectively cytotoxic against MOLT-3 cell line with IC50 values of 8.0, 5.4 and 9.8 μM, respectively, while only atalaphyllidine exhibited highest antioxidant activity as evaluated by DPPH free radical scavenging assay with an IC50 value of 22.4 μM.
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Affiliation(s)
- Phanruethai Pailee
- Laboratory of Natural Products, Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand
| | - Hunsa Prawat
- Laboratory of Natural Products, Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand
| | - Poonsakdi Ploypradith
- Laboratory of Medicinal chemistry, Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand; Program in Chemical Sciences, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand; Center of Excellence on Environmental Health and Toxicology (EHT), CHE, Ministry of Education, Bangkok, 10400, Thailand
| | - Chulabhorn Mahidol
- Laboratory of Natural Products, Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand; Program in Chemical Sciences, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand
| | - Somsak Ruchirawat
- Laboratory of Medicinal chemistry, Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand; Program in Chemical Sciences, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand; Center of Excellence on Environmental Health and Toxicology (EHT), CHE, Ministry of Education, Bangkok, 10400, Thailand
| | - Vilailak Prachyawarakorn
- Laboratory of Natural Products, Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand.
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Gilbert A, Williams C, Azuero A, Burkard ME, Kenzik K, Garrett-Mayer E, Meersman S, Rocque G. Utilizing Data Visualization to Identify Survival and Treatment Differences Between Women With De Novo and Recurrent Metastatic Breast Cancer. Clin Breast Cancer 2020; 21:292-301. [PMID: 33309481 DOI: 10.1016/j.clbc.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION De novo stage IV metastatic breast cancer (MBC) and recurrent MBC are considered the same when determining guideline-based care, but differences in treatment patterns exist. Data visualization can be used to understand these differences and optimize treatment delivery. PATIENTS AND METHODS This retrospective study evaluated treatment patterns for de novo and recurrent MBC using the American Society of Clinical Oncology's CancerLinQ Discovery database. Spatiotemporal graphics depicting treatment data were generated for MBC subtype and stratified by de novo and recurrent MBC. Descriptive statistics for categorical and continuous variables were calculated. RESULTS We identified 1668 patients diagnosed and treated for MBC: 391 patients with HER2+ MBC, 767 patients with HR+/HER2- MBC, and 510 patients with triple-negative MBC. Median survival from MBC diagnosis for patients with de novo MBC and recurrent MBC was 1.4 years (interquartile range, 0.6-3.0) and 1.8 years (interquartile range, 0.7-4.5), respectively. Both patients with de novo and recurrent HER2+ MBC were often treated with continuous HER2-targeted therapy. Patients with de novo HR+/HER2- MBC often received chemotherapy followed by hormone therapy. This contrasted with treatment trends observed among patients with recurrent HR+/HER2- MBC who, after receiving chemotherapy, seldom went on to receive hormone therapy. Patients diagnosed with triple-negative MBC displayed less heterogeneous treatment trends. CONCLUSION There are observable differences in survival and practice patterns between de novo and recurrent MBC. Visualization techniques are effective in assessing large databases and could give researchers and clinicians a clearer understanding of how survival differs by disease subtype, diagnosis status, and practice patterns.
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Affiliation(s)
- Aidan Gilbert
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Courtney Williams
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Mark E Burkard
- Department of Medicine and the UW Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI
| | - Kelly Kenzik
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth Garrett-Mayer
- Center for Research & Analytics (CENTRA), American Society of Clinical Oncology, Alexandria, VA
| | - Stephen Meersman
- Center for Research & Analytics (CENTRA), American Society of Clinical Oncology, Alexandria, VA
| | - Gabrielle Rocque
- Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL.
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Lin J, McRoy L, Fisher MD, Hu N, Davis C, Mitra D, Walker MS. Treatment patterns and clinical outcomes of palbociclib-based therapy received in US community oncology practices. Future Oncol 2020; 17:1001-1011. [PMID: 33167685 DOI: 10.2217/fon-2020-0744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Limited studies have evaluated palbociclib-based therapy use in patients with advanced/metastatic breast cancer in the real world. This retrospective study used medical records from US community oncology practices to address the gap. Materials & methods: Eligible patients receiving palbociclib-based therapy per label indication from 3 February 2015 to 31 December 2017 were included. Descriptive analyses were conducted for patient characteristics, treatment patterns and clinical outcomes. Results: The study included 233 patients who received palbociclib + aromatase inhibitor (P+AI) and 48 who received palbociclib + fulvestrant (P+F). Real-world progression-free rate for P+AI was 69.8% (46.8%) at 12 (24) months (P+F: 43.5% [39.9%]) months. Real-world survival rate was 89.8% (71.4%) at 12 (24) months (P+F: 76.3% [65.0%]). Conclusion: The study findings are consistent with previous studies of palbociclib-based therapy.
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Affiliation(s)
- Junji Lin
- Vector Oncology, an affiliate of ConcertAI, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Lynn McRoy
- Pfizer Inc., 235 East 42nd Street, NY 10017, USA
| | - Maxine D Fisher
- Vector Oncology, an affiliate of ConcertAI, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Nan Hu
- Vector Oncology, an affiliate of ConcertAI, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Cralen Davis
- Vector Oncology, an affiliate of ConcertAI, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | | | - Mark S Walker
- Vector Oncology, an affiliate of ConcertAI, 6555 Quince, Suite 400, Memphis, TN 38119, USA
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Beyond Chemotherapies: Recent Strategies in Breast Cancer Treatment. Cancers (Basel) 2020; 12:cancers12092634. [PMID: 32947780 PMCID: PMC7565588 DOI: 10.3390/cancers12092634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
In 2018, about 2.1 million women have been diagnosed with breast cancer worldwide. Treatments include-among others-surgery, chemotherapy, radiotherapy, or endocrine therapy. The current policy of care tends rather at therapeutic de-escalation, and systemic treatment such as chemotherapies alone are not systematically considered as the best option anymore. With recent advances in the understanding of cancer biology, and as a complement to anatomic staging, some biological factors (assessed notably via gene-expression signatures) are taken into account to evaluate the benefit of a chemotherapy regimen. The first aim of this review will be to summarize when chemotherapies can be avoided or used only combined with other treatments. The second aim will focus on molecules that can be used instead of chemotherapeutic drugs or used in combination with chemotherapeutic drugs to improve treatment outcomes. These therapeutic molecules have emerged from the collaboration between fundamental and clinical research, and include molecules, such as tyrosine kinase inhibitors, CDK4/6 inhibitors, and monoclonal antibodies (such as anti-PD-L1). In the fight against cancer, new tools aiding decision making are of the utmost importance: gene-expression signatures have proven to be valuable in the clinic, notably, to know when chemotherapies can be avoided. When substitution treatments are also available, a big step can be made toward personalized medicine for the patient's benefit.
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Schneeweiss A, Ettl J, Lüftner D, Beckmann MW, Belleville E, Fasching PA, Fehm TN, Geberth M, Häberle L, Hadji P, Hartkopf AD, Hielscher C, Huober J, Ruckhäberle E, Janni W, Kolberg HC, Kurbacher CM, Klein E, Lux MP, Müller V, Nabieva N, Overkamp F, Tesch H, Laakmann E, Taran FA, Seitz J, Thomssen C, Untch M, Wimberger P, Wuerstlein R, Volz B, Wallwiener D, Wallwiener M, Brucker SY. Initial experience with CDK4/6 inhibitor-based therapies compared to antihormone monotherapies in routine clinical use in patients with hormone receptor positive, HER2 negative breast cancer - Data from the PRAEGNANT research network for the first 2 years of drug availability in Germany. Breast 2020; 54:88-95. [PMID: 32956934 PMCID: PMC7509062 DOI: 10.1016/j.breast.2020.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 02/04/2023] Open
Abstract
Purpose Treatment with CDK4/6 inhibitors and endocrine therapy (CDK4/6i + ET) is a standard for patients with advanced hormone receptor–positive, HER2-negative (HR + HER2–) breast cancer (BC). However, real-world data on the implementation of therapy usage, efficacy, and toxicity have not yet been reported. Methods The PRAEGNANT registry was used to identify advanced HR + HER2– BC patients (n = 1136). The use of chemotherapy, ET, everolimus + ET, and CDK4/6i + ET was analyzed for first-line, second-line, and third-line therapy. Progression-free survival (PFS) and overall survival (OS) were also compared between patients treated with CDK4/6i + ET and ET monotherapy. Also toxicity was assessed. Results CDK4/6i + ET use increased from 38.5% to 62.7% in the first 2 years after CDK4/6i treatment became available (November 2016). Chemotherapy and ET monotherapy use decreased from 2015 to 2018 from 42.2% to 27.2% and from 53% to 9.5%, respectively. In this early analysis no statistically significant differences were found comparing CDK4/6i + ET and ET monotherapy patients with regard to PFS and OS. Leukopenia was was seen in 11.3% of patients under CDK4/6i + ET and 0.5% under ET monotherapy. Conclusions In clinical practice, CDK4/6i + ET has been rapidly implemented. A group of patients with a more unfavorable prognosis was possibly treated in the real-world setting than in the reported randomized clinical trials. The available data suggest that longer follow-up times and a larger sample size are required in order to identify differences in survival outcomes. Studies should be supported that investigate whether chemotherapy can be avoided or delayed in this patient population by using CDK4/6i + ET. CDK4/6i + ET use increased from 39% to 63% after becoming available. Chemotherapy and ET monotherapy use decreased from 42% to 27% and 53%–10%. There was no difference between CDK4/6i + ET and ET monotherapy regarding PFS and OS.
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Affiliation(s)
- Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncolo0gy and Tumour Immunology, Berlin, Germany
| | - Matthias W Beckmann
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | | | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany.
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
| | | | - Lothar Häberle
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Biostatistics Unit, Erlangen University Hospital, Department of Gynecology and Obstetrics, Erlangen, Germany
| | - Peyman Hadji
- Frankfurt Center of Bone Health Frankfurt, Germany
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | | | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | | | - Christian M Kurbacher
- Gynecology I (Gynecologic Oncology), Gynäkologisches Zentrum Bonn Friedensplatz, Bonn, Germany
| | - Evelyn Klein
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael P Lux
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Naiba Nabieva
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | | | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt, Germany
| | - Elena Laakmann
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Julia Seitz
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Christoph Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin Buch, Berlin, Germany
| | - Pauline Wimberger
- National Center for Tumor Diseases (NCT), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Carl Gustav Carus Faculty of Medicine and University Hospital, Technical University of Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics, Breast Center, and CCC Munich, Munich University Hospital, Germany
| | - Bernhard Volz
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
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