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Outcomes of CDK4/6 Inhibitors vs Weekly Paclitaxel in the Treatment of Patients With ER+/HER2− Advanced Breast Cancer With Impending or Established Visceral Crisis
TAKE-HOME MESSAGE
- This retrospective analysis investigated outcomes in patients with ER+/HER2− metastatic breast cancer with impending or established visceral crisis who received first-line weekly paclitaxel/nab-paclitaxel versus those who received a CDK4/6 inhibitor and endocrine therapy. All outcome measures, including median progression-free survival, overall survival, and time to treatment failure, favored the CDK4/6 inhibitor arm. The median time to first improvement in the visceral crisis was comparable between the paclitaxel and CDK4/6 inhibitor arms (3.6 weeks vs 3.9 weeks).
- This study challenges the current paradigm of using cytotoxic chemotherapy as the first-line treatment for patients with ER+/HER2− metastatic breast cancer with visceral crisis. These findings should be validated in prospective studies. The studied approach could significantly reduce toxicity and improve the quality of life in patients in this setting.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
ER+/HER2- advanced breast cancer (ABC) with visceral crisis (VC) or impending VC (IVC) is commonly treated with chemotherapy instead of CDK4/6 inhibitors (CDK4/6i). However, there is little evidence to confirm which treatment is superior. This study compared outcomes of patients with ER+/HER2- ABC and IVC/VC treated with CDK4/6i or weekly paclitaxel.
METHODS
Patients with ER+/HER2- ABC receiving first line treatment at a large tertiary UK cancer centre from 1-Mar-2017 to 30-Jun-2021 were retrospectively identified. Hospital records were screened for IVC/VC affecting the liver, lungs/mediastinum, gastrointestinal tract and/or bone marrow. Baseline demographics, clinical data and survival outcomes were recorded up to 30-Jul-2022.
RESULTS
27/396 (6.8%) patients with ABC who received CDK4/6i and 32/86 (37.2%) who received paclitaxel had IVC/VC. Median time to treatment failure (TTF), progression-free survival (PFS) and overall survival (OS) were significantly longer in the CDK4/6i compared to paclitaxel cohort: TTF 17.3 vs. 3.5 months (HR 0.33, 95%CI 0.17-0.61, p = 0.0002), PFS 17.8 vs. 4.5 months (HR 0.38, 95%CI 0.21-0.67, p = 0.002), OS 24.6 vs. 6.7 months (HR 0.37, 95%CI 0.20-0.68, p = 0.002). The median time to first improvement in IVC/VC was similar in patients receiving CDK4/6i compared to paclitaxel (3.9 vs. 3.6 weeks, p = 0.773). Disease control at 4 months was not significantly different in the CDK4/6i and paclitaxel cohorts (77.8% vs. 59.4%, p = 0.168). In multivariate analysis, treatment with CDK4/6i was independently associated with a longer PFS compared to paclitaxel (HR 0.31, 95%CI 0.12-0.78, p = 0.015).
CONCLUSION
In this retrospective study, patients with ER+/HER2- ABC and IVC/VC treated with CDK4/6i had a significantly better survival compared to those treated with weekly paclitaxel. Further prospective studies that minimise possible selection bias are recommended.
Additional Info
CDK4/6 inhibitors versus weekly paclitaxel for treatment of ER+/HER2- advanced breast cancer with impending or established visceral crisis
Breast Cancer Res Treat 2023 Aug 16;[EPub Ahead of Print], R Behrouzi, AC Armstrong, SJ HowellFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.