Advancing treatment choices: CDK4/6 inhibitor switching in HR+/HER2- metastatic breast cancer
Paola Zagami,
Angela Esposito,
Beatrice Taurelli Salimbeni,
Pier Paolo Maria Berton Giachetti,
Roberta Scafetta,
Matteo Lambertini,
Massimo Di Maio,
Giuseppe Curigliano,
Carmen Criscitiello,
Saverio Cinieri
Affiliations
Paola Zagami
Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
Angela Esposito
Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
Beatrice Taurelli Salimbeni
Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
Pier Paolo Maria Berton Giachetti
Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
Roberta Scafetta
Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
Matteo Lambertini
Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
Massimo Di Maio
Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
Giuseppe Curigliano
Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
Carmen Criscitiello
Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy; Corresponding author. European Institute of Oncology IRCCS, Via Ripamonti 435 University of Milano, Milan, Italy Milan Italy, 20141, Milan, Italy.
Saverio Cinieri
Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
Purpose: CDK4/6 inhibitors (CDK4/6i) use has revolutionized the treatment of hormone receptor-positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer. The choice of a specific CDK4/6i may be influenced by adverse events (AEs). Recently, the Italian Medicines Agency (AIFA) approved the possibility of switching between CDK4/6i for unacceptable toxicity. This study explores oncologists' experiences and future perspectives on CDK4/6 inhibitor switching following this new approval. Methods: With the support of the Italian Association of Medical Oncology (AIOM), we conducted a survey among 92 oncologists to assess the impact of AIFA's approval on patient management. Results: The survey showed that 48 % of participants were not surprised regarding AIFA's decision, with 76 % of respondents believing that this opportunity would significantly influence their treatment choices, enhancing AEs management for patients. Yet, 49 % of respondents emphasized the need for more real world evidence on CDK4/6i switch safety and efficacy. 96 % of respondents reported discontinuation rates between 0% and 25 % of patients, with constipation and hematological toxicity being the most frequent treatment discontinuation reasons. The oncologists prescribing CDK4/6i switch reported that most of these patients were in first line treatment (85 %) and the most common second CDK4/6i most frequently initiated was palbociclib (69 %), then abemaciclib (17 %) and ribociclib (14 %). Among those who started the second CDK4/6i at full dosage, 66 % of patients didn't require a dose reduction. Conclusion: Our survey highlights the importance of allowing CDK4/6i switching, thus likely prompting oncologists to adapt their treatment choices, leading to better AEs management for improving patients’ outcome.
