Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy

BACKGROUND

There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based).

METHODS

A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy.

RESULTS

The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months.

CONCLUSION

Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.

XLOT regimen instead of FLOT regimen in the primary treatment for patients with locally advanced and metastatic gastric cancer

AIMS

To evaluate the efficacy and safety of docetaxel plus oxaliplatin and capecitabine (XLOT) in the treatment of locally advanced and metastatic gastric adenocarcinoma.

METHODS AND MATERIAL

A total of 32 locally advanced gastric cancer (LAGC) and metastatic gastric cancer (MGC) patients in between 2019 to 2021 were enrolled into this study. Patients received XLOT regimen (docetaxel 50 mg/m2 and oxaliplatin 85 mg/m2 intravenous infusion on day 1, and capecitabine 2000 mg/day (day 1-14) orally. Treatment was repeated every three weeks.

STATISTICAL ANALYSIS USED

Statistical data analysis was performed using the Special Package for the Social Sciences (SPSS) version 25.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The Kaplan-Meier method was used for analyses of PFS and OS, and the two survival curves were compared using the log-rank test. A Chi-square test was used to compare independent group ratios. P values of < 0.05 were accepted as statistically significant.

RESULTS

The median age of 32 patients was 59.5 (26-79) years. The median cure count was 5 (1-11), and the median follow-up duration was 7 (3-19) months. The numbers of patients with compelete responsens (CRs), partial responses (PRs), stable disease (SD), and progressive disease (PD) were 6 (18.8%), 19 (59.4%), 5 (15.6%), and 2 (6.3%), respectively. The objective response rate (ORR) was 78.2%, with the disease control rate (DCR) of 93.8%. Median progression free survival (mPFS) and overall survival (mOS) were 11.7 (9.6-13.9) and 18.9 (15.4-22.3) month, respectively. The most common grade 3/4 toxicities were hematological toxicities. The most common toxicity was neutropenia which was observed in 18 (56.3%) patients. The most common grade 3/4 nonhematological toxicities were fatigue, nausea, vomiting, diarrhea.

CONCLUSIONS

The XLOT regimen demonstrated a promising efficacy as the first-line regimen in treating locally advanced and metastatic gastric cancer patients. Toxicities were tolerated and controllable.

Enhanced topical delivery of dexamethasone by β-cyclodextrin decorated thermoresponsive nanogels

Highly hydrophilic, responsive nanogels are attractive as potential systems for the topical delivery of bioactives encapsulated in their three-dimensional polymeric scaffold. Yet, these drug carrier systems suffer from drawbacks for efficient delivery of hydrophobic drugs. Addressing this, β-cyclodextrin (βCD) could be successfully introduced into the drug carrier systems by exploiting its unique affinity toward dexamethasone (DXM) as well as its role as topical penetration enhancer. The properties of βCD could be combined with those of thermoresponsive nanogels (tNGs) based on dendritic polyglycerol (dPG) as a crosslinker and linear thermoresponsive polyglycerol (tPG) inducing responsiveness to temperature changes. Electron paramagnetic resonance (EPR) studies localized the drug within the hydrophobic cavity of βCD by differences in its mobility and environmental polarity. In fact, the fabricated carriers combining a particulate delivery system with a conventional penetration enhancer, resulted in an efficient delivery of DXM to the epidermis and the dermis of human skin ex vivo (enhancement compared to commercial DXM cream: ∼2.5 fold in epidermis, ∼30 fold in dermis). Furthermore, DXM encapsulated in βCD tNGs applied to skin equivalents downregulated the expression of proinflammatory thymic stromal lymphopoietin (TSLP) and outperformed a commercially available DXM cream.