First- and second-line treatment strategies for hormone-receptor (HR)-positive HER2-negative metastatic breast cancer: A real-world study

Basile, Debora; Gerratana, Lorenzo; Corvaja, Carla; Pelizzari, Giacomo; Franceschin, Giorgia; Bertoli, Elisa; Palmero, L.; Zară, D; Alberti, Marco; Buriolla, Silvia; Ros, Lucia Da; Bonotto, Marta; Mansutti, M.; Spazzapan, Simon; Cinausero, M.; Minisini, Alessandro Marco; Fasola, Gianpiero; Puglisi, Fabio

doi:10.1016/j.breast.2021.02.015

Cited by 19 publications

(26 citation statements)

References 37 publications

(42 reference statements)

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“…Usually, patients who have endocrine resistance are not recommended to use ET for HR+ ABC by Chinese expert consensus ( 13 ). Third, compared with ET, the higher response rates and faster response associated with CT may cause clinicians to prescribe CT to patients with rapidly progressive and symptomatic disease ( 14 , 34 ). This may be attributed to the vast heterogeneity in metastatic disease characteristics among these patients and the lack of clear prognostic indicators to guide physicians in identifying which patients may benefit from CT or ET.…”

Section: Discussionmentioning

confidence: 99%

“…The authors reported that 35.3% of patients with HR+/HER2-metastatic BC received ET as front-line treatment, and 17.2% of patients who had neither visceral metastasis nor progression on (neo)adjuvant ET wrongly received CT instead of ET (32). However, in Europe and America, only 25-56% of patients receive CT in the first-line metastatic setting, which is obviously different from that in China (14,(32)(33)(34). In addition, 56.53% of patients received maintenance treatment after the disease was effectively controlled by CT, and maintenance ET (58.42%) was preferred.…”

Section: Discussionmentioning

confidence: 99%

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Real-World First-Line Treatment Patterns and Outcomes in Hormone Receptor-Positive Advanced Breast Cancer Patients: A Multicenter, Retrospective Study in China

et al. 2022

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BackgroundRecent data on first-line treatment patterns administered to hormone receptor-positive (HR+) advanced breast cancer (ABC) patients in the real-world setting are limited. This study aimed to report the first-line treatment patterns and outcomes of HR+ ABC patients in China.MethodsThis was a multicenter, noninterventional study. Eligible patients were cytologically or histologically confirmed to have HR+ ABC with ≥2 complete medical records and received first-line therapies between January 2015 and June 2019. Treatment patterns and outcomes were extracted from structured or unstructured electronic medical records. Progression-free survival (PFS) was analyzed with the Kaplan-Meier method.ResultsIn total, 1072 patients with HR+ ABC were enrolled at 6 treatment sites: 327 human epidermal growth factor receptor 2-positive (HER2+) patients, 696 HER2-negative (HER2-) patients and 49 HER2-unknown patients. Overall, 62.41% of patients received first-line chemotherapy (CT), 21.08% received targeted therapy (TT) and 15.49% received endocrine therapy (ET). For HR+/HER2+ patients, 65.14% received TT, 28.44% received CT, and 5.81% received ET. Compared with patients who received TT, patients who received CT alone, had a significantly worse median PFS (adjusted hazard ratio [HR] =2.59, 95% confidence interval [CI], 1.64-4.10, p<0.001). For HR+/HER2- patients, 77.01% received CT, 20.69% received ET and 1.15% received TT. Compared with patients who received ET, patients who received CT with maintenance therapy had a significantly prolonged median PFS (adjusted HR =0.57, 95% CI, 0.44-0.76, p<0.001). Among HR+/HER2- patients who received CT with maintenance treatment, those with maintenance ET had a longer median PFS than those with maintenance CT, but the difference was not significant (adjusted HR=0.92, 95% CI, 0.64-1.33, p=0.66).ConclusionsThis real-world study demonstrates that CT remains the mainstream first-line treatment option for HR+ patients in China. Among patients with HR+/HER2+ ABC, the majority received first-line TT and experienced a PFS benefit. A high percentage of HR+/HER2- patients received CT as first-line therapy in clinical practice. PFS benefit was significantly longer in patients who received CT with maintenance therapy. Moreover, there was no obvious difference in PFS between maintenance ET and CT. Maintenance ET may be a better choice considering its lower toxicity and better quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Real-World First-Line Treatment Patterns and Outcomes in Hormone Receptor-Positive Advanced Breast Cancer Patients: A Multicenter, Retrospective Study in China

et al. 2022

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“…A real-world retrospective study, conducted by Basile et al showed that after a first-line treatment with CDK4/6i, 60% of the patients were treated with CHT and 40% with ET. Patients who received ET had a better prognosis, but the authors failed to identify any significant factor with an influence on the choice of treatment after CDK4/6i [ 49 ].…”

Section: Treatment Strategies After Cdk4/6i: What Is Known What Is On...mentioning

confidence: 99%

“…As we could expect, a worse prognosis was identified for patients treated with CHT after CDK4/6i. The authors analyzed the potential factors that could have influenced the choice of second-line treatment, but they didn’t find any that seems to drive the choice of subsequential ET or CHT [ 49 ].…”

Section: Treatment Strategies After Cdk4/6i: What Is Known What Is On...mentioning

confidence: 99%

How to Treat HR+/HER2- Metastatic Breast Cancer Patients after CDK4/6 Inhibitors: An Unfinished Story

Cogliati¹,

Capici²,

Pepe³

et al. 2022

Life

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CDK4/6 inhibitors in association with endocrine therapy represent the best therapeutic choice for either endocrine-sensitive or resistant hormone-receptor-positive advanced breast cancer patients. On the contrary, the optimal therapeutic strategy after the failure of CDK4/6 inhibitors-based treatment still remains an open question worldwide. In this review, we analyze the most studied mechanisms of resistance to CDK4/6 inhibitors treatment, as well as the most significant results of retrospective and prospective trials in the setting of progression after CDK4/6 inhibitors, to provide the reader a comprehensive overview from both a preclinical and especially a clinical perspective. In our opinion, an approach based on a deeper knowledge of resistance mechanisms to CDK4/6 inhibitors, but also on a careful analysis of what is done in clinical practice, can lead to a better definition of prospective randomized trials, to implement a personalized sequence approach, based on molecular analyses.

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“…These seminal studies have open the way to the testing of specific CDK4 and CDK6 small molecule inhibitors (hereafter CDK4/6i) to treat human tumors, in particular estrogen receptor positive (ER+) breast cancers, in which their use, combined with hormonal therapies, has proved highly effective in the control of disease progression [ 14 , 15 , 16 , 17 ].…”

Section: The Role Of Cdk4 and Cdk6 In The Control Of Cell Cycle Progressionmentioning

confidence: 99%

Inhibition of CDK4/6 as Therapeutic Approach for Ovarian Cancer Patients: Current Evidences and Future Perspectives

Dall'Acqua

Bartoletti

Masoudi-Khoram

et al. 2021

Cancers

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Alterations in components of the cell-cycle machinery are present in essentially all tumor types. In particular, molecular alterations resulting in dysregulation of the G1 to S phase transition have been observed in almost all human tumors, including ovarian cancer. These alterations have been identified as potential therapeutic targets in several cancer types, thereby stimulating the development of small molecule inhibitors of the cyclin dependent kinases. Among these, CDK4 and CDK6 inhibitors confirmed in clinical trials that CDKs might indeed represent valid therapeutic targets in, at least some, types of cancer. CDK4 and CDK6 inhibitors are now used in clinic for the treatment of patients with estrogen receptor positive metastatic breast cancer and their clinical use is being tested in many other cancer types, alone or in combination with other agents. Here, we review the role of CDK4 and CDK6 complexes in ovarian cancer and propose the possible use of their inhibitors in the treatment of ovarian cancer patients with different types and stages of disease.

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First- and second-line treatment strategies for hormone-receptor (HR)-positive HER2-negative metastatic breast cancer: A real-world study

Cited by 19 publications

References 37 publications

Real-World First-Line Treatment Patterns and Outcomes in Hormone Receptor-Positive Advanced Breast Cancer Patients: A Multicenter, Retrospective Study in China

Real-World First-Line Treatment Patterns and Outcomes in Hormone Receptor-Positive Advanced Breast Cancer Patients: A Multicenter, Retrospective Study in China

How to Treat HR+/HER2- Metastatic Breast Cancer Patients after CDK4/6 Inhibitors: An Unfinished Story

Inhibition of CDK4/6 as Therapeutic Approach for Ovarian Cancer Patients: Current Evidences and Future Perspectives

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