CDK4/6 Inhibitors as First-Line Options in Metastatic Breast Cancer


Expert perspectives on differentiating between the three CDK4/6 inhibitors available for the treatment of metastatic breast cancer are discussed, highlighting factors that inform treatment selection.

This is a synopsis of a Peer Exchange series featuring Aimee Keegan, PharmD, BCOP, of City of Hope.

In this video, Aimee Keegan, PharmD, BCOP, discusses the selection of CDK4/6 inhibitors as first-line agents for patients with metastatic breast cancer. Dr. Keegan explains that City of Hope is data-driven and considers guidelines and trial results when determining the most appropriate agent.

According to Dr. Keegan, the most commonly prescribed CDK4/6 inhibitor at City of Hope is ribociclib, due to the statistically significant overall survival benefit demonstrated in the MONALEESA trial. The Monarch trial, which evaluated abemaciclib, showed similar overall survival results but did not achieve statistical significance, making ribociclib the preferred choice over abemaciclib when all other factors are equal. Palbociclib, studied in the PALOMA trial, did not show any significant overall survival benefit and has fallen out of favor among the three agents.

However, Dr. Keegan emphasizes that individual patient characteristics must also be considered when selecting a CDK4/6 inhibitor. For example, if a patient presents with pre-existing QTc prolongation, ribociclib may not be the best choice due to its unique side effect of QT prolongation. In such cases, abemaciclib may be a more suitable option. Similarly, if a patient has possible central nervous system (CNS) disease, physicians may prefer abemaciclib due to its documented CNS activity.

Furthermore, patients with multiple comorbidities, such as cardiac dysfunction and colitis, may not tolerate either ribociclib or abemaciclib. In these cases, palbociclib would be the first choice due to its tolerability, even though it did not demonstrate an overall survival benefit in clinical trials.

Dr. Keegan concludes that while trial results are crucial in guiding the selection of CDK4/6 inhibitors, individual patient characteristics and adverse effect profiles must also be carefully considered to ensure the best possible treatment outcomes.

*Video synopsis is AI-generated and reviewed by Pharmacy Times editorial staff.

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