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Buyukbayram ME, Hannarici Z, Duzkopru Y, Turhan A, Caglar AA, Coban Esdur P, Bilici M, Tekin SB, Yazılıtaş D. The Effect of C-Reactive Protein/Lymphocyte Ratio (CLR) on PFS in Metastatic Breast Cancer Patients Treated with CDK4/6 Inhibitors: A Novel Biomarker. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:329-339. [PMID: 38974895 PMCID: PMC11227876 DOI: 10.2147/bctt.s464161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
Objective Hormone positive breast cancer is a tumor with high mortality. Combining antihormonal therapy with cyclin dependent kinase 4/6 inhibitors (CDK4/6i) has resulted in longer survival. The effect of inflammatory parameters such as c-reactive protein and c-reactive protein/lymphocyte ratio (CLR) on efficacy and survival in CDK4/6i treatment is unknown. In our study, we aimed to investigate the role of CLR and some parameters in predicting progression-free survival (PFS) with CDK4/6i. Methods This retrospective cohort study included 78 patients with denovo and recurrent metastatic breast cancer treated with CDK4/6i. Cut off values for the prediction of mortality by various numerical parameter scores were performed by ROC Curve analysis. The effect of clinical variables, inflammatory and histopathological parameters on survival was analyzed by Kaplan-Meier method. Results Neutrophil/lymphocyte ratio (NLR) and CLR were statistically significant in predicting mortality (p < 0.05). Ki67 and CLR were correlated with PFS. Age and CLR were correlated with OS (p < 0.05). CLR was statistically significant for both PFS (p = 0.022) and OS (p = 0.006). Conclusion In patients with metastatic hormone-positive breast cancer using CDK4/6i, low CLR and low Ki67 were correlated with longer PFS duration.
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Affiliation(s)
| | - Zekeriya Hannarici
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Yakup Duzkopru
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Aykut Turhan
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | | | - Pınar Coban Esdur
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Mehmet Bilici
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Salim Basol Tekin
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Doğan Yazılıtaş
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
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Yoshinami T, Nagai SE, Hattori M, Okamura T, Watanabe K, Nakayama T, Masuda H, Tsuneizumi M, Takabatake D, Harao M, Yoshino H, Mori N, Yasojima H, Oshiro C, Iwase M, Yamaguchi M, Sangai T, Kosaka N, Tajima K, Masuda N. Real-world progression-free survival and overall survival of palbociclib plus endocrine therapy (ET) in Japanese patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer in the first-line or second-line setting: an observational study. Breast Cancer 2024; 31:621-632. [PMID: 38642245 PMCID: PMC11194199 DOI: 10.1007/s12282-024-01575-5] [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: 12/28/2023] [Accepted: 03/22/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND A recent large real-world study conducted in the United States reported the effectiveness of palbociclib plus aromatase inhibitor in HR+/HER2- advanced breast cancer (ABC). However, local clinical practice and available medical treatment can vary between Japan and Western countries. Thus, it is important to investigate Japanese real-world data. This observational, multicenter study (NCT05399329) reports the interim analysis of effectiveness of palbociclib plus ET as first-line or second-line treatment for HR+/HER2- ABC by estimating real-world progression-free survival (rwPFS) and overall survival (OS) in Japanese routine clinical practice. METHODS Real-world clinical outcomes and treatment patterns of palbociclib plus ET were captured using a medical record review of patients diagnosed with HR+/HER2- ABC who had received palbociclib plus ET in the first-line or second-line treatment across 20 sites in Japan. The primary endpoint was rwPFS; secondary endpoints were OS, real-world overall response rate, real-world clinical benefit rate, and chemotherapy-free survival. RESULTS Of the 677 eligible patients, 420 and 257 patients, respectively, had received palbociclib with ET as first-line and second-line treatments. Median rwPFS (95% confidence interval) was 24.5 months (19.9-29.4) for first-line and 14.5 months (10.2-19.0) for second-line treatment groups. Median OS was not reached in the first-line group and was 46.7 months (38.8-not estimated) for the second-line group. The 36-month OS rates for de novo metastasis, treatment-free interval (TFI) ≥ 12 months, and TFI < 12 months were 80.2% (69.1-87.7), 82.0% (70.7-89.3), and 66.0% (57.9-72.9), respectively. CONCLUSION The addition of palbociclib to ET was effective for treating HR+/HER2- ABC in Japanese routine clinical practice.
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Affiliation(s)
- Tetsuhiro Yoshinami
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Masaya Hattori
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Takuho Okamura
- Department of Breast Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kenichi Watanabe
- Department of Breast Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroko Masuda
- Department of Breast Surgical Oncology, School of Medicine, Showa University, Tokyo, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Daisuke Takabatake
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Michiko Harao
- Department of Breast Oncology, Jichi Medical University, Shimotsuke, Japan
| | - Hiroshi Yoshino
- Breast and Endocrinological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Natsuko Mori
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Hiroyuki Yasojima
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Chiya Oshiro
- Department of Breast Surgery, Kaizuka City Hospital, Kaizuka, Japan
| | - Madoka Iwase
- Department of Breast and Endocrine Surgery, Nagoya University Hosipital, Nagoya, Japan
| | - Miki Yamaguchi
- Department of Breast Surgery, JCHO Kurume General Hospital, Kurume, Japan
| | - Takafumi Sangai
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | | | - Kentaro Tajima
- Oncology Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Hosipital, Nagoya, Japan.
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
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3
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Brain E, Chen C, Simon S, Pasupuleti V, Pfitzer KV, Gelmon KA. Palbociclib in Older Patients with Advanced/Metastatic Breast Cancer: A Systematic Review. Target Oncol 2024; 19:303-320. [PMID: 38546943 PMCID: PMC11111485 DOI: 10.1007/s11523-024-01046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Palbociclib in combination with endocrine therapy is approved for treatment of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer. In addition to clinical trials, several real-world studies have evaluated the effectiveness of palbociclib. With increased life expectancy in the general population, breast cancer in older women is also expected to increase. OBJECTIVE The aim was to systematically review evidence from both clinical trials and real-world studies for palbociclib treatment outcomes in older patients with HR+/HER2- advanced/metastatic breast cancer (a/mBC). Older patients are often underrepresented in clinical trials, and real-world evidence (RWE) will enrich the analysis of palbociclib outcomes in this subgroup of patients. DESIGN A systematic literature search in PubMed, EMBASE, and Cochrane Library through May 4, 2023, yielded 2355 unique articles. A total of 52 articles (13 and 39 articles reporting results from seven randomized controlled trials [RCTs] and 37 RWE studies, respectively) were included based on study eligibility criteria. RESULTS All RCTs used age cutoffs of ≥ 65 years to define older population (n = 722; 437 received palbociclib); all RWE studies, except one with an age cutoff of > 60 years, had age cutoffs of ≥ 65 years or higher to define older population (n = 9840; 7408 received palbociclib). Overall, in studies that compared efficacy (progression-free survival [seven RCTs, 20 RWE studies], overall survival [four RCTs, 11 RWE studies], tumor response [three RWE studies], and clinical benefit rate [one RCT, two RWE studies]) and safety outcomes (three RCTs, three RWE studies) between older and younger patients, palbociclib showed similar benefits, regardless of age. Results from two RCTs and two RWE studies showed that global quality of life (QoL) was maintained in older patients receiving palbociclib. Overall, palbociclib dose modifications (two RWE studies), dose reductions (one RCT, seven RWE studies), and treatment discontinuation rates (three RCTs, three RWE studies) were higher in older patients compared with younger patients; however, these differences did not appear to adversely impact efficacy outcomes. CONCLUSIONS In this systematic review, data from RCTs showed that palbociclib was effective, well tolerated, and maintained QoL in older patients with HR+/HER2- a/mBC. Palbociclib treatment in older patients in real-world settings was associated with similar clinical benefit as in RCTs. PROSPERO REGISTRATION CRD42023444195.
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Affiliation(s)
- Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Paris, France
| | | | | | | | | | - Karen A Gelmon
- Faculty of Medicine, University of British Columbia, and BC Cancer, 600 W 10th Ave, Vancouver, BC, V5Z 1M9, Canada.
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Palmieri C, Musson A, Harper-Wynne C, Wheatley D, Bertelli G, Macpherson IR, Nathan M, McDowall E, Bhojwani A, Verrill M, Eva J, Doody C, Chowdhury R. A real-world study of the first use of palbociclib for the treatment of advanced breast cancer within the UK National Health Service as part of the novel Ibrance® Patient Program. Br J Cancer 2023; 129:852-860. [PMID: 37468569 PMCID: PMC10449843 DOI: 10.1038/s41416-023-02352-5] [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: 11/14/2022] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The Ibrance® Patient Program was established to provide access to palbociclib for UK National Health Service (NHS) patients with metastatic breast cancer (MBC), pending a funding decision. METHODS Non-interventional cohort study involving a retrospective medical record review of patients commenced on palbociclib between April and December 2017 at eight UK centres. Primary outcomes included clinicopathological characteristics, treatment patterns, clinical outcomes and selected adverse events. RESULTS Overall, 191 patients were identified, median age of 57.0 years (range 24.3-90.9); 30% were diagnosed with de novo MBC; 72% received first-line and 10% as ≥ second-line treatment. Median progression-free survival (95% CI) was 22.8 months (16.5-not reached [NR]) in first-line; NR in patients with de novo MBC; 7.8 months (6.8-NR) in ≥ second-line (median follow-up: 24 months). Median overall survival (OS) was NR in the overall cohort; OS rate (95% CI) at 24 months was 74.2% (67.1-81.9%) in first-line; 82.1% (72.6-92.8%) in patients with de novo MBC; 55.0% (37.0-81.8%) in ≥ second-line. Forty-seven per cent of patients developed grade 3-4 neutropenia; 3% febrile neutropenia. CONCLUSION This study supports the effectiveness of palbociclib and demonstrates the benefit to patients of early access schemes that bridge the gap between regulatory approval and NHS funding for new medicines. CLINICAL TRIAL REGISTRATION Clinical trial: ClinicalTrial.gov:NCT03921866.
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Affiliation(s)
- Carlo Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
| | | | | | - Duncan Wheatley
- Department of Oncology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | | | | | - Mark Nathan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Ajay Bhojwani
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Mark Verrill
- Department of Medical Oncology, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Joe Eva
- OPEN Health, The Weighbridge, Brewery Courtyard, High Street, Marlow, UK
| | - Colm Doody
- Pfizer UK, Walton Oaks, Dorking Rd, Tadworth, UK
| | - Ruhe Chowdhury
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Pfizer UK, Walton Oaks, Dorking Rd, Tadworth, UK
- Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
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5
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Yang J, Zhao B, Ling X, Li D, Zhao J, Lv Y, Wang G, Liu X, Li N, Yang J. Palbociclib plus endocrine therapy in hormone receptor-positive and HER2 negative metastatic breast cancer: a multicenter real-world study in the northwest of China. BMC Cancer 2023; 23:103. [PMID: 36717797 PMCID: PMC9885675 DOI: 10.1186/s12885-023-10568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Real-world data of Palbociclib are insufficient in China. This study aimed to investigate the treatment pattern and real-world outcomes in hormone receptor positive and human epidermal growth factor 2 receptor negative (HR+/HER2-) metastatic breast cancer (MBC) patients treated with Palbociclib in the northwest of China. METHODS HR+/HER2- MBC patients who received Palbociclib in 8 centers from July 2017 to September 2019 were retrospectively included in this study. Real-world objective response rate (ORR), progression-free survival (PFS) and safety profiles were analyzed. The survival curves were plotted by the Kaplan-Meier method to analyze PFS, which was verified by the log-rank test. RESULTS In total, 211 women were eligible for the analysis. A total of 85 patients (40.3%), 78 (37.0%), and 48 (22.7%) received Palbociclib in the first-, second-, third- or later-line setting, respectively. 46 patients achieved partial response and 145 patients experienced stable disease, with an ORR of 21.8% and a disease control rate of 90.5%. Following a median follow-up period of 14.2 months, the median PFS was 12.2 months (95% confidence interval, 10.1-14.3 m), and the median overall survival was not reached. Early Palbociclib initiation, sensitivity or acquired resistance to endocrine therapy, estrogen receptor and progesterone receptor double positivity, less than 3 metastatic sites, without visceral metastasis, bone metastasis only, without prior chemotherapy or endocrine therapy were associated with a prolonged PFS in MBC (All P < 0.05). The most common grade 3 or 4 adverse events (AE) was neutropenia (36.5%), and the most common nonhematologic AE was fatigue (10.9%). No patient experienced AE leading to treatment discontinuation. CONCLUSION Palbociclib plus endocrine therapy exhibited favorable effectiveness and manageable toxicities in the real-world setting, supporting their use in Chinese patients with HR+/HER2 - MBC.
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Affiliation(s)
- Jiao Yang
- grid.452438.c0000 0004 1760 8119Departments of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, 710061 Xi’an, Shaanxi P.R. China
| | - Bing Zhao
- grid.13394.3c0000 0004 1799 3993Breast Internal Medicine Department, The 3rd Affiliated Teaching Hospital of XinJiang Medical University (Affiliated Tumor Hospital), No. 789 Suzhou East Road, Xinshi District, 830011 Urumqi, Xinjiang China
| | - Xiaoling Ling
- grid.412643.60000 0004 1757 2902Department of Oncology, The First Hospital of Lanzhou University, Lanzhou University, 730000 Lanzhou, Gansu China
| | - Donghui Li
- grid.440288.20000 0004 1758 0451Department of Medical Oncology, Shaanxi Provincial People’s Hospital, 710068 Xi’an, Shaanxi China
| | - Jiuda Zhao
- grid.262246.60000 0004 1765 430XBreast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Yonggang Lv
- grid.412262.10000 0004 1761 5538Department of Thyroid Breast Surgery, the Affiliated Hospital of Northwest University, Xi’an No.3 Hospital, Xi’an, Shaanxi China
| | - Guangxi Wang
- Department of Medical Oncology, Shaanxi Provincial Tumor Hospital, Xi’an, China
| | - Xinlan Liu
- grid.413385.80000 0004 1799 1445Department of Oncology, General Hospital of Ningxia Medical University, 750004 Yinchuan, Ningxia China
| | - Nanlin Li
- grid.233520.50000 0004 1761 4404Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, 710032 Xi’an, China
| | - Jin Yang
- grid.452438.c0000 0004 1760 8119Departments of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, 710061 Xi’an, Shaanxi P.R. China
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6
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Real-World Treatment Patterns and Clinical Outcomes Associated With Palbociclib Combination Therapy: A Multinational, Pooled Analysis From the Ibrance Real World Insights Study. Clin Ther 2022; 44:1588-1601. [DOI: 10.1016/j.clinthera.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/22/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
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Zhang Y, Chen W, Chen S, Yang Q, Ouyang Z. Early Application of Palbociclib Plus Endocrine Therapy in HR+/HER2- Metastatic Breast Cancer: A Better Choice Based on Data From the Chinese Population. Technol Cancer Res Treat 2022; 21:15330338221132926. [PMID: 36310472 PMCID: PMC9623362 DOI: 10.1177/15330338221132926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Palbociclib is the most widely used cyclin-dependent kinase 4/6 inhibitor in China, but its early application efficacy on Chinese metastatic breast cancer (MBC) patients was reported deficiently. Methods: Between February 2019 to December 2021, 95 female hormone receptor-positive (HR+)/human epidermal growth factor receptor-2 negative (HER2-) patients with MBC received palbociclib combined with AI or fulvestrant were retrospectively analyzed in our center. The primary outcome was progression-free survival (PFS). The objective response rate and clinical benefit rate (CBR) were evaluated. Results: The median follow-up period was 15 months (range from 2 to 37). Palbociclib performed superiorly when applicated in first-and-second line therapy than in later lines (P = .002). Palbociclib combined with AI or fulvestrant had a median PFS of 34 months (95% confidence interval [CI] = 6.87-61.13) and 12 months (95%CI = 7.76-16.24), respectively. Univariate subgroup analysis showed that the previous history of salvage chemotherapy (P = .015) and the presence of liver metastases (P < .001) significantly affected the efficacy of palbociclib. Despite the existence of liver metastases and primary endocrine resistance, which are two independent predictors of poor prognosis, early application of palbociclib in advanced stage can bring further benefits to these two groups of patients, rather than choosing salvage chemotherapy in the first place. Conclusion: Palbociclib combined with endocrine therapy has a favorable efficacy and acceptable toxicity in HR+/HER2- Chinese MBC patients. Better performance can be seen when palbociclib was applicated in the early stage.
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Affiliation(s)
- Yusi Zhang
- The First Affiliated Hospital of
Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian,
China
| | - Wenlin Chen
- The First Affiliated Hospital of
Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian,
China
| | - Shuanglong Chen
- The First Affiliated Hospital of
Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian,
China
| | - Qingmo Yang
- The First Affiliated Hospital of
Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian,
China,Qingmo Yang, MD, Department of Breast
Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine,
Xiamen University, Xiamen Fujian 361003, China.
| | - Zhong Ouyang
- The First Affiliated Hospital of
Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian,
China,Zhong Ouyang, MD, Department of Breast
Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine,
Xiamen University, Xiamen Fujian 361003, China.
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8
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Jian W, Xue J, Yao Q, Chen R, Yao Y, Wang M, Zhou T. Starting dose selection of palbociclib in Chinese patients with breast cancer based on population kinetic-pharmacodynamic model of neutropenia. Cancer Chemother Pharmacol 2022; 90:489-497. [PMID: 36271947 DOI: 10.1007/s00280-022-04484-6] [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: 05/04/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022]
Abstract
Neutropenia is the most common adverse event (AE) of palbociclib, an oral CDK4/6 inhibitor for breast cancer. Neutropenia increases the risk of infection and is even life threatening. Asian patients generally suffer more severe neutropenia from palbociclib treatment, but the label does not recommend a reduction in the starting dose for Asian patients. Therefore, the study aimed to explore the exposure-response (E-R) relationship in Chinese patients and preliminarily generate a scale for starting dose selection of palbociclib in Chinese patients. After comparing the kinetic-pharmacodynamic (K-PD) and the pharmacokinetic/pharmacodynamic (PK/PD) model, a semi-mechanistic K-PD model was selected and developed on the basis of real-world data from 28 patients with breast cancer to describe the time course of longitudinal absolute neutrophil counts (ANC). The longitudinal ANC data were well described by the population K-PD model with reasonable parameters: mean transit time (MTT) of 198 h, feedback parameter (γ) of 0.317, baseline ANC level (Circ0) of 3.36 × 109 L-1, drug effect coefficient (kd) of 0.0349, and drug effect power (β) of 0.383. No covariate was included in the final model. The model showed that palbociclib dose-dependently reduced ANC levels in a Chinese population, and lower baseline ANC level was associated with more severe neutropenia. The dose selection scale suggested that palbociclib 125 mg daily was appropriate for Chinese patients with Circ0 higher than 3.75 × 109 L-1. In summary, the K-PD model of palbociclib well described the longitudinal ANC in Chinese patients. Besides, the starting dose selection scale may provide reference for clinicians during individualized therapy.
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Affiliation(s)
- Weizhe Jian
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Junsheng Xue
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Qingyu Yao
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Rong Chen
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Ye Yao
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Mopei Wang
- Department of Tumor Chemotherapy and Radiation Sickness, Peking University Third Hospital, Beijing, 100191, China.
| | - Tianyan Zhou
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China.
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9
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Shen L, Zhou J, Chen Y, Ding J, Wei H, Liu J, Xia W, Xie B, Xie X, Li X, Dai Y, Zhang G, Qiu X, Li C, Sun S, Chen W, Gong D, Li H, Huang J, Jiang X, Ni C. Treatment patterns, effectiveness, and patient-reported outcomes of palbociclib therapy in Chinese patients with advanced breast cancer: A multicenter ambispective real-world study. Cancer Med 2022; 11:4157-4168. [PMID: 35470572 DOI: 10.1002/cam4.4767] [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: 12/29/2021] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palbociclib was the only available cyclin-dependent kinase 4/6 inhibitor in China until very recently, and its effect has not been systemically evaluated among Chinese patients. This study aims to assess the efficacy, safety and patient-reported outcomes (PROs) of palbociclib plus endocrine therapy (ET) in real-world China. METHODS An ambispective cohort study was conducted on patients with advanced HR+HER2- breast cancer who received palbociclib between July 2018, and November 2020 and were enrolled from 12 hospitals. Treatment patterns, survival outcomes, and safety events were documented, and PROs (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 items [EORTC QLQ-C30] and EuroQoL 5 dimensions [EQ-5D]) were analyzed. The Kaplan-Meier method was used to visualize and estimate the median progression-free survival (mPFS). Log-rank tests, Cox regressions, t tests, and chi-square tests were performed for comparison. RESULTS A total of 190 patients (median follow-up of 18.0 months) were enrolled. Palbociclib was mostly combined with aromatase inhibitors (66.3%), fulvestrant (32.6%), and tamoxifen (1.1%). The mPFS values were 21.0, 14.0, and 7.0 months with palbociclib administered in first- (n = 83), second- (n = 41) and subsequent-line settings (n = 66), respectively. Endocrine sensitivity was significantly associated with patient prognosis (mPFS: 23.0, 12.0, and 6.0 months for endocrine naïve, acquired, and primary resistant patients, respectively, p < 0.01). The outcome was worse for patients who failed to meet the inclusion criteria of PALOMA-3 than for those who met the criteria (later-line: 6.0 months vs. 9.0 months). The most common adverse events (AEs) were neutropenia (74.2%; grade 3/4: 30.0%), fatigue (48.4%), anemia (32.6%), and thrombocytopenia (22.1%). PRO data suggested that palbociclib plus ET significantly improved cognitive and emotional function, pain symptoms, and overall quality of life. CONCLUSIONS Palbociclib is effective for front-line use and for treating endocrine-sensitive patients in real-world China and is generally well tolerated. The prevalence of AEs in the Chinese population is different from that reported in the PALOMA-2/3 trials.
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Affiliation(s)
- Lesang Shen
- Department of Breast Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.,Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
| | - Jun Zhou
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University, Hangzhou, China
| | - Yiding Chen
- Department of Breast Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jinhua Ding
- Department of Breast Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Haiyan Wei
- Department of Breast Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jian Liu
- Department of Breast Surgery, Affiliated Hangzhou First People's Hospital of Zhejiang University, Hangzhou, China
| | - Wenjie Xia
- Department of Breast Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Bojian Xie
- Department of Breast Surgery, Taizhou Enze Medical Center Enze Hospital, Taizhou, China
| | - Xiaohong Xie
- Department of Breast Surgery, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xujun Li
- Department of Breast Surgery, Hwa Mei Hospital University of Chinese Academy of Sciences, Ningbo, China
| | - Yuechu Dai
- Department of Breast Surgery, Taizhou Municipal Hospital, Taizhou
| | - Guobing Zhang
- Quality Management Office, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Xia Qiu
- Department of Breast Surgery, Zhoushan Hospital of Zhejiang University, Zhoushan, China
| | - Chao Li
- Department of Breast Surgery, Hwa Mei Hospital University of Chinese Academy of Sciences, Ningbo, China
| | - Shanshan Sun
- Department of Breast Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.,Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
| | - Wuzhen Chen
- Department of Breast Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.,Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
| | - Dihe Gong
- Department of Breast Surgery, Ningbo Hangzhou Bay Hospital, Ningbo, China
| | - Hengyu Li
- Department of General Surgery, Affiliated Changhai Hospital of The Second Military Medical University, Shanghai, China
| | - Jian Huang
- Department of Breast Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.,Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
| | - Xia Jiang
- Department of Nutrition, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.,Department of Clinical Neuroscience, Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Chao Ni
- Department of Breast Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.,Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
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10
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Cardoso Borges F, Alves da Costa F, Ramos A, Ramos C, Bernardo C, Brito C, Mayer-da-Silva A, Furtado C, Ferreira AR, Martins-Branco D, Miranda A, Lourenço A. Real-world effectiveness of palbociclib plus fulvestrant in advanced breast cancer: Results from a population-based cohort study. Breast 2022; 62:135-143. [PMID: 35182993 PMCID: PMC8859011 DOI: 10.1016/j.breast.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background Real-world (RW) data may provide valuable information on the effectiveness and safety of medicines, which is particularly relevant for clinicians, patients and third-party payers. Evidence on the effectiveness of palbociclib plus fulvestrant is scarce, which highlights the need of additional studies. The aim of this study was to evaluate the effectiveness of palbociclib plus fulvestrant in advanced breast cancer (ABC). Materials and methods We conducted a population-based retrospective cohort study and cases of interest were identified through the Portuguese National Cancer Registry database and additional data sources. Patients aged≥18 years, diagnosed with ABC and exposed to palbociclib plus fulvestrant between May 31, 2017 and March 31, 2019 were included. Patients were followed-up until death or cut-off date (February 28, 2021). Primary outcome was rw-progression-free survival (rwPFS). Secondary outcomes were rw-overall survival (rwOS), rw-time to palbociclib failure (rwTPF) and rw-time to next treatment (rwTTNT). Results A total of 210 patients were included. Median age was 58 years (range 29–83) and 99.05% were female. Median follow-up time was 23.22 months and, at cut-off date, treatment had been discontinued in 189 patients, mainly due to disease progression (n = 152). Median rwPFS was 7.43 months (95% confidence interval [CI] 6.28–9.05) and 2-year rwPFS was 16.65% (95%CI 11.97–22.00). Median rwOS was 24.70 months (95%CI 21.58–29.27), median rwTPF was 7.5 months (95%CI 6.51–9.08) and median rwTTNT was 11.74 months (95%CI 10.33–14.08). Conclusion Palbociclib plus fulvestrant seems an effective treatment for ABC in real-world context. Compared to registrations studies, rwPFS and rwOS were shorter in real-life setting. Palbociclib plus fulvestrant seems to be an effective therapy for ABC in real-world. Median rwPFS and rwOS were estimated at 7.43 and 24.70 months, respectively. Our data suggest lower effectiveness in real-world than the efficacy reported. Treatment was discontinued due to AEs in 8.09% of patients, suggesting good tolerability. Registries may generate effectiveness data and support clinical and HTA decisions.
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Affiliation(s)
- Fábio Cardoso Borges
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Filipa Alves da Costa
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal; Department of Pharmacy, Pharmacology and Health Technologies, Faculty of Pharmacy, University of Lisbon (FFULisboa), Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
| | - Adriana Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Catarina Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Catarina Bernardo
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Cláudia Brito
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Alexandra Mayer-da-Silva
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Cláudia Furtado
- Health Technology Assessment Department, Autoridade Nacional Do Medicamento e Produtos de Saúde (INFARMED), Parque da Saúde de Lisboa, Avenida Do Brasil, 53, 1749-004, Lisboa, Portugal.
| | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisboa, Portugal.
| | - Diogo Martins-Branco
- Academic Trials Promoting Team, Institute Jules Bordet, Rue Meylemeersch 90, 1070, Bruxelles, Belgium; Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - Ana Miranda
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
| | - António Lourenço
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
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11
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The Impact of Real-World Alternative Dosing Strategies of Palbociclib on Progression-Free Survival in Patients with Metastatic Breast Cancer. Curr Oncol 2022; 29:1761-1772. [PMID: 35323345 PMCID: PMC8946878 DOI: 10.3390/curroncol29030145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Palbociclib, a cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitor, in combination with letrozole or fulvestrant has been demonstrated to prolong the progression-free survival (PFS) in patients with hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) metastatic breast cancer. In efforts to mitigate neutropenic toxicities, oncologists in real-world practice have prescribed alternative dosing strategies with palbociclib, yet the implication on PFS is unknown. Methods: We conducted a retrospective, observational chart review of all female patients at our clinics with HR+, HER2- metastatic breast cancer receiving palbociclib in combination with either letrozole or fulvestrant with a first dose initiated between June 2016 and December 2018 and followed their disease course until 30 April 2020. Results: The median PFS for all clinic patients receiving palbociclib and letrozole (n = 63) was 40.8 months (95% confidence interval (CI) 25.6–not estimable) and 16.97 months (95% CI 8.57–not estimable) for patients receiving palbociclib and fulvestrant (n = 11). We identified seven alternative dosing strategies prescribed by oncologists, the most prevalent being prescribing palbociclib for three weeks on and two weeks off (n = 8). The Kaplan–Meier curves for PFS in patients receiving letrozole and palbociclib prescribed alternative dosing strategies appear to diverge from monograph dosing early in the treatment. Many patients prescribed palbociclib using alternative dosing strategies continued to be observed even by the 18-month timepoint. The prevalence of grade 4 neutropenia was lower for patients on palbociclib with letrozole, suggesting a possible mitigation of severe neutropenia with alternative dosing strategies. Conclusions: We conclude that alternative dosing strategies used by oncologists such as prescribing palbociclib for three weeks on, two weeks off may achieve comparable disease control while mitigating neutropenic toxicities when compared to standard monograph dosing recommendations, prolonging treatment tolerability and adherence. Further large-scale studies are needed to confirm these results for future clinical adoption.
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Kim JY, Oh JM, Park YH, Ahn JS, Im YH. Which Clinicopathologic Parameters Suggest Primary Resistance to Palbociclib in Combination With Letrozole as the First-Line Treatment for Hormone Receptor-Positive, HER2-Negative Advanced Breast Cancer? Front Oncol 2021; 11:759150. [PMID: 34745997 PMCID: PMC8566811 DOI: 10.3389/fonc.2021.759150] [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] [Received: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 01/12/2023] Open
Abstract
In this study, we evaluated clinical parameters to predict the primary resistance of palbociclib in combination with endocrine therapy as the first-line treatment in patients with hormone receptor (HR)+, human epidermal growth factor receptor 2 (HER2)- metastatic breast cancer (MBC). We performed a data analysis of patients diagnosed with HR+, HER2-MBC who received palbociclib plus letrozole as the first-line treatment in the metastatic setting from the clinical data warehouse in Samsung Medical Center. In this study, 305 patients were included in the final data analysis. The median follow-up duration was 31 months, and we observed 123 cases of disease progression. The median progression-free survival (PFS) was 28.7 months, and 38 patients (12.5%) had less than a 6-month PFS. The multivariate analysis suggested that primary resistance to adjuvant endocrine therapy (ET) (hazard ratio: 1.91), presence of liver metastasis (hazard ratio: 2.17), initial elevation of serum CA-15-3 (hazard ratio: 1.99), weak positivity of estrogen receptor (ER) (hazard ratio: 2.28), Ki-67 3+ or 4+ (hazard ratios: 2.58 and 10.28), and presence of mutation (hazard ratio: 9.59) were associated with a short PFS duration. A further prediction model was developed with data from 256 patients and 33 cases of disease progression in 6 months. This model included five factors-primary resistance to adjuvant ET (odds ratio, OR: 1.14), liver metastasis (OR: 1.56), initial CA-15-3 elevation (OR: 1.51), weak ER expression (OR: 2.22), and BRCA2 mutation (OR: 2.85)-and the area under the receiver operating characteristic curve was 0.842 (95% CI: 0.775, 0.909; p < 0.001). Finally, we divided them into four risk groups according to the prediction model with the five risk factors. These four groups had different PFS (p < 0.001) and primary resistance of palbociclib with letrozole [OR of group 2 vs. group 1 (ref): 2.18 (p = 0.002), OR of group 3: 3.91 (p < 0.001), and OR of group 4: 4.25 (p < 0.001)]. We developed a prediction model of primary resistance to palbociclib with letrozole as the first-line treatment for HR+, HER2-MBC. Our prediction model might be helpful for considering the first-line treatment strategies. Further well-designed clinical trials would be warranted to validate our prediction model.
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Affiliation(s)
- Ji-Yeon Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Min Oh
- Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Hyuck Im
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Multicentric real world evidence with palbociclib in hormone positive HER2 negative metastatic breast cancer in Indian population. Sci Rep 2021; 11:16236. [PMID: 34376758 PMCID: PMC8355114 DOI: 10.1038/s41598-021-95758-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
The combination of cyclin dependent kinase 4/6 inhibitors with endocrine therapy is the standard therapy in hormone receptor positive HER-2 negative metastatic breast cancer (HR+/HER2− MBC). Several randomized trials have shown the benefits of this combination, however, real world evidence in the Indian patients is warranted. The present study reports the largest real world multicentric data from Indian population on the use of Palbociclib in HR+/HER2− MBC. A multicentric study on the HR+/HER2− MBC patients who received palbociclib with hormonal agent (Aromatase inhibitors/Fulvestrant) between February 2017 and May 2020 was conducted. Clinical and demographic information and survival data was retrieved from the Hospital medical records. Among a total of 188 patients, 57% patients were premenopausal and 17% patients had bone only disease. Altogether, 115 (61%) patients received palbociclib with Aromatase inhibitors in the first line whereas 73 (39%) patients received it in the second line with Fulvestrant. The median follow up period with advanced disease was 13 months. The median progression free survival in the first line and second line was 20.2 months and 12 months, respectively (p-value < 0.0001). The objective response rate was 80% and 47.9% in first and second lines, respectively. Dose interruptions/ discontinuation were done in 14.9% and 2.7% patients in the first and second lines, respectively. In terms of toxicity, 10% patients had grade 3–4 adverse events. The present real world data of the use of palbociclib in Indian population suggests similar effectiveness to previously published real world evidences and has been adapted as the standard of care in the first and second line treatment of HR+/HER2− MBC.
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