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Tan A, Nong L, Wang H, Jia Y, Zhong W, Qin F, Wang H, Tang J, Liu Y, Lu Y. Phase II study of apatinib plus exemestane in estrogen receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer. Cancer Biol Ther 2023; 24:2265055. [PMID: 37831547 PMCID: PMC10578185 DOI: 10.1080/15384047.2023.2265055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE Apatinib is a tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor (VEGFR)-2. This study was conducted to assess the efficacy and safety of apatinib combined with exemestane in patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). METHODS This single-center, single-arm phase II study enrolled patients with ER+/HER2- MBC progressed on previous letrozole or anastrozole. Stratified analysis was performed according to the number of chemotherapy regimens for metastatic disease. The primary endpoint was progression free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), clinical benefit rate (CBR), overall survival (OS) and toxicity. Patients received apatinib at a starting dose of 500 mg/d and exemestane 25 mg/d on days 1-28 of each 4-week cycle. RESULTS Thirty patients were enrolled with median four prior anticancer therapies. Eighty percent of patients received chemotherapy for metastatic disease. The median PFS (mPFS) and OS were 5.6 (95%CI: 4.3-6.9) months and 15.7 (95% CI: 9.7-21.7) months, respectively. The ORR, DCR, and CBR were 21.4%, 71.4%, and 46.4%, respectively. Patients with 0-1 line chemotherapy for MBC showed a slightly longer mPFS compared to those with ≥2 lines chemotherapy (mPFS: 6.4 months vs 4.8 months, P = .090). Most of the AEs were grade 1/2. One patient (3.3%) who suffered bone marrow metastases experienced grade 4 thrombocytopenia, and 14 experienced grade 3 AEs. Fifty percent of patients were given reduced dose for apatinib. CONCLUSIONS Apatinib plus exemestane exhibited objective efficacy in patients with ER+/HER2- MBC who have failed multiple lines of treatment. The AEs of apatinib required close monitoring and most of patients were well tolerated.
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Affiliation(s)
- Aihua Tan
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Li Nong
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Hongxue Wang
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Yuxian Jia
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Wuning Zhong
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Fanghui Qin
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Han Wang
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jing Tang
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Yan Liu
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Yongkui Lu
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
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Beddok A, Porte B, Cottu P, Fourquet A, Kirova Y. [Biological, preclinical and clinical aspects of the association between radiation therapy and CDK4/6 inhibitors]. Cancer Radiother 2023; 27:240-248. [PMID: 37080859 DOI: 10.1016/j.canrad.2022.11.003] [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: 05/28/2022] [Revised: 10/06/2022] [Accepted: 11/30/2022] [Indexed: 04/22/2023]
Abstract
Several clinical studies have shown that CDK4/6 inhibitors (CDK4/6i) improve survival in patients with metastatic or locally advanced HR-positive, HER-2-negative breast cancer (BC). The aim of this review was to synthesize the biological, preclinical and clinical aspects of the treatment of BC with CDK4/6i, with a focus on the combination of CDK4/6i and radiotherapy. The DNA damage induced after exposure of cells to ionizing radiation activates control pathways that inhibit cell progression in the G1 and G2 phases and induce a transient delay in progression in the S phase. These checkpoints are in particular mediated by cyclin-dependent kinases (CDK) 4/6 activated by cyclin D1. Several preclinical studies have shown that CDK4/6i could be used as radiosensitizers in non-small cell lung cancer, medulloblastoma, brainstem glioma and breast cancer. CDK4/6 inhibition also protected against radiation-induced intestinal toxicities by inducing redistribution of quiescent intestinal progenitor cells, making them less radiosensitive. Clinical data on the combination of CDK inhibitors and radiotherapy for both locoregional and metastatic irradiation are based on retrospective data. Nevertheless, the most optimal therapeutic sequence would be radiotherapy followed by palbociclib. Pending prospective clinical trials, the concomitant combination of the two treatments should be done under close supervision.
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Affiliation(s)
- A Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898 Orsay, France; Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France.
| | - B Porte
- Service d'oncologie médicale, GHU hôpital européen Georges-Pompidou, Paris, France
| | - P Cottu
- Département d'oncologie médicale, Institut Curie, Paris, France
| | - A Fourquet
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris, France
| | - Y Kirova
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris, France
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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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Shao X, Zheng Y, Cao W, Shen X, Li G, Chen J, Huang Y, Huang P, Shi L, Ye W, Zou W, Lou C, Lei L, Huang J, Chen Z, Wang X. Ki67 and progesterone receptor status predicts sensitivity to palbociclib: a real-world study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:707. [PMID: 33987405 PMCID: PMC8106007 DOI: 10.21037/atm-21-1340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Palbociclib combined with endocrine therapy has been approved as a front-line treatment for hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer (ABC). A key challenge remains to uncover biomarkers to identify those patients who may benefit from palbociclib treatment. Methods We retrospectively analyzed the values of Ki67 and progesterone receptor (PR) as detected by immunohistochemistry in 81 ABC patients with palbociclib and hormone therapy treatment, and evaluated the impact on progression-free survival (PFS). Results In the total population, women with Ki67 ≥14% had marginally significantly shorter PFS than those with Ki67 <14% (P=0.062). Patients with Ki67 ≥30% had significantly shorter PFS than those with Ki67 <30% (P=0.048). Meanwhile, PR ≥20% was associated with longer PFS. Moreover, the change of Ki67 or PR from primary tissue to metastatic lesions was related to PFS. As for the hormone therapy subgroup, there were significant associations between Ki67 and PR levels and PFS in the aromatase inhibitors (AIs) subgroup. Patients with Ki67 ≥14% or Ki67 ≥30% had shorter PFS than those with Ki67 <14% or Ki67 <30%, respectively (P=0.024, P<0.001). Additionally, the change of Ki67 or PR from primary tissue to metastatic lesions was related to PFS. When both Ki67 and PR were considered, there were significant differences between the different cohorts. Compared with patients with Ki67 ≥14% and PR <20%, those with Ki67 <14% and PR ≥20% had significantly longer PFS. In addition, patients with Ki67 <30% and PR ≥20% had significantly longer PFS than those with Ki67 ≥30% and PR <20%. Furthermore, in the AI cohort, patients with Ki67 <14% and PR ≥20% had significantly longer PFS than those with Ki67 ≥14% and PR <20%. Women with Ki67 <30% and PR ≥20% had significantly longer PFS than those with Ki67 ≥30% and PR <20%. Conclusions The present study indicates that both Ki67 and PR have great impacts on palbociclib and hormone therapy and may contribute to selecting more effective partners for palbociclib.
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Affiliation(s)
- Xiying Shao
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Yabing Zheng
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Wenming Cao
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Xiabo Shen
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Guangliang Li
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Junqing Chen
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Yuan Huang
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Ping Huang
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Lei Shi
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Weiwu Ye
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Weibin Zou
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Caijin Lou
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Lei Lei
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Jian Huang
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Zhanhong Chen
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Xiaojia Wang
- Department of Medical Oncology (Breast Cancer), Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou, China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
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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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6
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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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7
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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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Edman Kessler L, Wiklander O, Hamberg E, Bergh J, Foukakis T, Matikas A. Efficacy and safety of cyclin dependent kinases 4/6 inhibitors in the treatment of metastatic breast cancer: a real-world experience. Acta Oncol 2020; 59:1382-1387. [PMID: 32783667 DOI: 10.1080/0284186x.2020.1804613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Randomized trials have shown survival gains for patients with metastatic breast cancer (BC) treated with CDK4/6 inhibitors (CDK4/6i) in combination with endocrine agents. It is not unlikely that there may be discrepancies between the generally fit clinical study population and the real-world setting that could affect adherence to treatment guidelines, tolerance to treatment and outcome. MATERIAL AND METHODS Consecutive patients with metastatic or locally advanced and unresectable BC that were treated between July 2017 and January 2020 at Karolinska University Hospital, Stockholm, Sweden and that had received at least one dose of CDK4/6i were included in this retrospective study. The primary endpoint was safety, including toxicity according to CTCAE 5 and rates of treatment interruptions, dose reductions and discontinuations. The secondary endpoint was efficacy based on the treating physicians' assessments in terms of progression free (PFS) and overall survival (OS), as well as the factors associated with patient outcome. RESULTS Eighty-eight patients were included in the analysis, with a median age of 67.2 years. Grade 4 neutropenia occurred in 9.1% of patients and one episode of neutropenic infection was observed. Dose reductions were made in 38.6% of patients, while 11.4% discontinued treatment due to toxicity, most commonly non-hematologic. After a median follow-up of 18.33 months, median PFS was 13.30 months (95% CI, 11.39-15.21) and median OS could yet not be estimated. In multivariable analysis, number of prior chemotherapy lines was an independent predictor for shorter PFS (HR = 3.28, 95% CI 1.50-7.16, p = .003). CONCLUSIONS CDK4/6i administered in a real-world setting exhibits a similar toxicity profile but higher incidence of treatment discontinuation compared to randomized trials. Efficacy of CDK4/6i among patients pretreated with multiple therapy lines is markedly reduced.
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Affiliation(s)
- Luisa Edman Kessler
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Oscar Wiklander
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Hamberg
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Theodoros Foukakis
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Alexios Matikas
- Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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9
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KovaČ A, Matos E, Kuhar CG, Čakš M, Ovčariček T, Mencinger M, Humar M, Borštnar S. Efficacy and safety of selective cyclin-dependent kinases 4/6 inhibitors in hormone-receptor-positive, HER2-negative advanced breast cancer - results from a real-world setting. Cancer Treat Res Commun 2020; 25:100201. [PMID: 32979704 DOI: 10.1016/j.ctarc.2020.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Selective cyclin-dependent kinases 4/6 inhibitors (CDKi) have become the standard of care in patients with hormone receptor (HR)-positive, HER2-negative advanced breast cancer (ABC). We performed retrospective analysis in patients treated with CDKi in the first year of their routine clinical use in Slovenia. METHODS The primary goals were time-to-treatment failure (TTF) and overall survival (OS), analysed via Kaplan-Meier method, the secondary goals were clinical benefit rate (CBR) and safety. RESULTS Overall, 218 patients' data were evaluated. The median age was 61.8 years (30.6-84.6). The median number of previous ET lines for ABC was 2 (range 0-5). At the time of inclusion, 128 patients (58.7%) had visceral metastases, 45 patients (20.6%) had bone-only disease. At the median follow-up of 15.2 months, disease progressed in 74 patients and 60 patients died. The median TTF was 8.3 months for the whole group, 19.3, 10.3 and 5.5 months for patients treated in the first-, second- and further lines of systemic therapy, respectively. The median OS from the start of CDKi treatment was not reached in any of the groups. CBR was 59.6% for the whole group, 42.7% for further lines of therapy. The most common grade 3/4 adverse event was neutropaenia in 108 patients (49.5%), followed by an increase of hepatic aminotransferases in 13 patients (6.0%). CONCLUSIONS Even in the diverse real-world population treatment with CDKi in combination with ET showed clinical benefit, most prominently in the first- and second lines of systemic therapy.
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Affiliation(s)
- Anja KovaČ
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; Izola General Hospital, Polje 40, 6310 Izola, Slovenia.
| | - Erika Matos
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | | | - Marina Čakš
- University Clinical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Tanja Ovčariček
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Marina Mencinger
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Mojca Humar
- General Hospital "dr. Franc Derganc" Nova Gorica, Ulica padlih borcev 13A, 5290 Šempeter pri Gorici, Slovenia
| | - Simona Borštnar
- Institute of Oncology Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia.
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Demir A, Mandel NM, Paydas S, Demir G, Er Ö, Turhal NS, Bavbek S, Eralp Y, Saip PM, Güler EN, Aydıner A, Oyan Uluç B, Kılıçkap S, Üskent N, Karadurmuş N, Kaplan MA, Yanmaz MT, Demir H, Alan Ö, Korkmaz T, Olgun P, Sönmez Uysal Ö, Altundağ K, Gündüz Ş, Günaldı M, Sarı M, Beypınar İ, Başaran G. Efficacy of Palbociclib and Endocrine Treatment in Heavily Pretreated Hormone Receptor-positive/HER2-negative Advanced Breast Cancer: Retrospective Multicenter Trial. Balkan Med J 2020; 37:104-107. [PMID: 31970972 PMCID: PMC7094190 DOI: 10.4274/balkanmedj.galenos.2020.2019.11.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The synthesis of CDK4/6 inhibitors with endocrine treatment in two series of treatment has been widely accepted as the standard for patients with estrogen receptor-positive metastatic breast cancer. In spite of this, the activity of CDK4/6 inhibitors in patients with metastatic breast cancer who have progressed despite receiving multiple lines of treatment is not well understood. Aims: To report the activity and safety of a CDK4/6 inhibitor (palbociclib) in patients in whom at least three lines of treatment for ER+ metastatic breast cancer had failed. Study Design: Multicenter retrospective observational cohort study. Methods: In this retrospective observational cohort study, we included 43 patients who received palbociclib after at least three lines of systemic treatment for ER+/HER2− metastatic breast cancer. Results: The median progression-free survival in our population was 7 months (25th-75th percentile, 4-10), and the median overall survival was 11 months (25th-75th percentile, 6-19). Although there were some adverse events, palbociclib was generally well tolerated, so dose reduction was needed for only six patients (14%). Conclusion: The efficacy of palbociclib among heavily treated hormone receptor-positive/HER2− patients with advanced breast cancer was acceptable in terms of clinical benefit, and it was generally well tolerated among this population.
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Affiliation(s)
- Atakan Demir
- Department of Medical Oncology, Acıbadem University, İstanbul, Turkey
| | | | - Semra Paydas
- Department of Medical Oncology, Çukurova University School of Medicine, Adana, Turkey
| | - Gökhan Demir
- Department of Medical Oncology, Acıbadem University, İstanbul, Turkey
| | - Özlem Er
- Department of Medical Oncology, Acıbadem University, İstanbul, Turkey
| | | | | | - Yeşim Eralp
- Department of Medical Oncology, Acıbadem University, İstanbul, Turkey
| | - Pınar Mualla Saip
- Department of Medical Oncology, İstanbul University Oncology Institute, İstanbul, Turkey
| | - Emine Nilüfer Güler
- Department of Medical Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Adnan Aydıner
- Department of Medical Oncology, İstanbul University Oncology Institute, İstanbul, Turkey
| | - Başak Oyan Uluç
- Department of Medical Oncology, Acıbadem University, İstanbul, Turkey
| | - Sadettin Kılıçkap
- Department of Medical Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Necdet Üskent
- Clinic of Oncology, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Nuri Karadurmuş
- Clinic of Medical Oncology T.C. Ministry of Health Gülhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Kaplan
- Department of Medical Oncology, Dicle University School of Medicine, Diyarbakır, Turkey
| | | | - Hacer Demir
- Department of Medical Oncology Afyon Kocatepe University School of Medicine, Afyon, Turkey
| | - Özkan Alan
- Tekirdağ State Hospital, Tekirdağ, Turkey
| | - Taner Korkmaz
- Department of Medical Oncology, Acıbadem University, İstanbul, Turkey
| | - Polat Olgun
- Near East University Hospital, Lefkoşa, TRNC
| | | | | | | | - Meral Günaldı
- Clinic of Medical Oncology, Florya Medical Park Hospital, İstanbul, Turkey
| | | | - İsmail Beypınar
- Department of Medical Oncology Afyon Kocatepe University School of Medicine, Afyon, Turkey
| | - Gül Başaran
- Department of Medical Oncology, Acıbadem University, İstanbul, Turkey
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11
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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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12
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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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Xi J, Oza A, Thomas S, Naughton M, Ademuyiwa F, Weilbaecher K, Suresh R, Bose R, Cherian M, Hernandez-Aya L, Frith A, Peterson L, Luo J, Krishnamurthy J, Ma CX. Retrospective Analysis of Treatment Patterns and Effectiveness of Palbociclib and Subsequent Regimens in Metastatic Breast Cancer. J Natl Compr Canc Netw 2019; 17:141-147. [PMID: 30787127 PMCID: PMC6752198 DOI: 10.6004/jnccn.2018.7094] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/10/2018] [Indexed: 01/19/2023]
Abstract
Background: Cyclin-dependent kinase (CDK) 4/6 inhibitors are now the standard of care for hormone receptor-positive (HR+), HER2-negative (HER-) metastatic breast cancer (MBC). However, guidelines are lacking regarding their optimal sequencing with other available agents. This study examines physician practice patterns and treatment outcomes of palbociclib and subsequent therapies in a real-world setting. Methods: A retrospective chart review was conducted for consecutive patients with MBC who received palbociclib between February 2015 and August 2017 at the Alvin J. Siteman Cancer Center. Kaplan-Meier method was used to generate time-to-event curves and estimate median progression-free survival (mPFS). Log-rank test was used to compare differences. Results: A total of 200 patients, with a median age of 59.4 years and a follow-up of 19.5 months, were included. Palbociclib was most frequently combined with letrozole (73.5%), followed by fulvestrant (25%), anastrozole (1%), and tamoxifen (0.5%). Most patients received palbociclib in the endocrine-resistant setting (n=42, n=50, and n=108 in the first-, second-, and subsequent-line settings, respectively), and the fraction of patients receiving palbociclib as first- or second-line therapy increased in recent months (P=.0428). mPFS was 20.7, 12.8, and 4.0 months with palbociclib administered in the first-, second-, and subsequent-line settings, respectively (P<.0001). Incidences of grade 3/4 neutropenia (41.5%) and dose reductions (29%) were comparable to reports in the literature. Among patients whose disease progressed on palbociclib (n=104), the most frequent next-line treatment was capecitabine (n=21), followed by eribulin (n=16), nab-paclitaxel (n=15), and exemestane + everolimus (n=12). mPFS with hormone therapy alone or in combination with targeted agents (n=32) after first-, second-, and subsequent-line palbociclib was 17.0, 9.3, and 4.2 months, respectively (P=.04). mPFS with chemotherapy (n=70) was not reached, 4.7, and 4.1 months after first-, second-, and subsequent-line palbociclib, respectively (P=.56). Conclusions: Palbociclib is effective for HR+/HER2- MBC in real-world practice. Hormone therapy alone or in combination with targeted agents remains an effective option after palbociclib progression.
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Affiliation(s)
- Jing Xi
- Washington University School of Medicine, St. Louis, MO 63110
- St. Luke’s Hospital, St. Louis, MO 63017
| | - Aabha Oza
- Washington University School of Medicine, St. Louis, MO 63110
| | - Shana Thomas
- Washington University School of Medicine, St. Louis, MO 63110
| | | | | | | | - Rama Suresh
- Washington University School of Medicine, St. Louis, MO 63110
| | - Ron Bose
- Washington University School of Medicine, St. Louis, MO 63110
| | - Mathew Cherian
- Washington University School of Medicine, St. Louis, MO 63110
| | | | - Ashley Frith
- Washington University School of Medicine, St. Louis, MO 63110
| | | | - Jingqin Luo
- Washington University School of Medicine, St. Louis, MO 63110
| | | | - Cynthia X. Ma
- Washington University School of Medicine, St. Louis, MO 63110
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