Among patients with HR+/ERBB2− MBC treated with CDK4/6 inhibitors, we observed that ERBB2-low expression was associated with an inferior PFS. This may serve as a potential marker candidate associated with CDK4/6 inhibitor efficacy. An intrinsic subtypes genomic analysis of the MONALEESA studies 3 found that, overall, the ERBB2-enriched (formerly HER2-enriched) subtype was associated with 2.3-fold increased risk of disease progression compared with the luminal A subtype. Our results provide phenotypical evidence suggesting the inferior efficacy of CDK4/6 inhibitors in the ERBB2-low expression subgroup. Some limitations of this study include its retrospective nature with limited sample size, the lack of patients receiving abemaciclib, and the lack of data on PIK3CA mutation status. Given novel anti-ERBB2 antibody-drug conjugates, such as trastuzumab deruxtecan, demonstrated clinical efficacy in ERBB2-low-expressing MBC, 4 coupled with emerging evidence supporting the combination use of CDK4/6 inhibitors with anti-ERBB2 agents, 5 this subgroup may be of high clinical relevance and warrant prospective evaluations in future trials.
BackgroundPalliative care providers serving Chinese patients lack a culture-specific model of communication, a strong evidence base for this and clear guidance on its application. Thus, providers find it challenging to address patients’ dignity, and determine their priorities and preferences for treatments and care, at the patients’ final stage of life.AimThis study explores the culture-specific influences and current understanding of end-of-life (EOL) communication in the Chinese context.MethodsA qualitative systematic review of qualitative studies was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycINFO, PubMed and ERIC databases were searched for studies between January 1994 and July 2019, using keywords ‘end of life’, ‘terminal care’, ‘communication’ and ‘Chinese’. Included studies were appraised with Critical Appraisal Skills Programme criteria.ResultsThe search strategy yielded 982 entries and 13 studies were included. Six themes were identified in EOL communication in the Chinese context: (1) Chinese philosophies on the meaning of ‘good death’. (2) Negative attitudes towards communication on dying. (3) EOL communication as a taboo topic. (4) Clinician-centred approaches to treatment-decision making. (5) Family expectations being prioritised over patient self-autonomy in prognosis disclosure. (6) Care-providers expressing puzzlement over cultural preferences regarding EOL communication.ConclusionsThe review detailed the complexity of EOL communication in the Chinese context, urging for a communication model distinct from Western-based practices. Future research could explore a validated communication framework that addresses the local culture, thus enabling an understanding of patients’ priorities and interpreting EOL encounters from a cross-cultural perspective.
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