Comparison of the Effectiveness and Clinical Outcome of Everolimus Followed by CDK4/6 Inhibitors with the Opposite Treatment Sequence in Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: In hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer (HR+ HER2-MBC), the mainstay treatment options include cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) and everolimus (EVE) in combination with endocrine treatment. This study aims to compare the outcomes of the following treatment sequences: CDK4/6i followed by EVE and EVE followed by CDK4/6i. Materials and methods: Data from HR+ HER2- MBC patients treated between January 2014 and November 2020 with both CDK4/6i and EVE were retrospectively analyzed. Results: Among the 88 patients included in the study, 51 received CDK4/6i before EVE (C→E group), and 37 received EVE before CDK4/6i (E→C group) with endocrine treatment. More patients in the E→C group had endocrine resistance (13.7% vs. 40.5%), experienced palliative chemotherapy (7.8% vs. 40.5%), and were heavily treated (treated as ≥ 3rd line, 5.9% vs. 40.5%). Median overall survival was 46.8 months in the C→E group and 38.9 months in the E→C group (p=0.151). Median composite progression-free survival (PFS), defined as the time from the start of the preceding regimen to disease progression on the following regimen or death, was 24.8 months in the C→E group vs. 21.8 months in the E→C group (p=0.681). Median PFS2/PFS1 ratio did not differ significantly between groups (0.5 in the C→E group, 0.6 in the E→C group; p=0.775). Ten patients (11.4%) discontinued EVE, and two patients (2.3%) discontinued CDK4/6i during treatment. Conclusion: Although the CDK4/6i-based regimen should be considered as an earlier line of treatment, CDK4/6i- and EVE-based treatments can be valid options in circumstances where the other treatment had been already given.
Abstract
Purpose: In hormone receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer (HR+ HER2-MBC), the mainstay treatment options include cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) and everolimus (EVE) in combination with endocrine treatment. This study aims to compare the outcomes of the following treatment sequences: CDK4/6i followed by EVE and EVE followed by CDK4/6i. Materials and methods: Data from HR+ HER2- MBC patients treated between January 2014 and November 2020 with both CDK4/6i and EVE were retrospectively analyzed. Results: Among the 88 patients included in the study, 51 received CDK4/6i before EVE (C→E group), and 37 received EVE before CDK4/6i (E→C group) with endocrine treatment. More patients in the E→C group had endocrine resistance (13.7% vs. 40.5%), experienced palliative chemotherapy (7.8% vs. 40.5%), and were heavily treated (treated as ≥ 3rd line, 5.9% vs. 40.5%). Median overall survival was 46.8 months in the C→E group and 38.9 months in the E→C group (p=0.151). Median composite progression-free survival (PFS), defined as the time from the start of the preceding regimen to disease progression on the following regimen or death, was 24.8 months in the C→E group vs. 21.8 months in the E→C group (p=0.681). Median PFS2/PFS1 ratio did not differ significantly between groups (0.5 in the C→E group, 0.6 in the E→C group; p=0.775). Ten patients (11.4%) discontinued EVE, and two patients (2.3%) discontinued CDK4/6i during treatment. Conclusion: Although the CDK4/6i-based regimen should be considered as an earlier line of treatment, CDK4/6i- and EVE-based treatments can be valid options in circumstances where the other treatment had been already given.
참고문헌 (25)
- Finn RS, "Palbociclib and letrozole in advanced breast cancer", N Engl J Med, 375, pp.1925~1936 (2016)
- Goetz MP, "MONARCH 3 : abemaciclib as initial therapy for advanced breast cancer", J Clin Oncol, 35, pp.3638~3646 (2017)
- Hortobagyi GN, "Ribociclib as first-line therapy for HR-positive, advanced breast cancer", N Engl J Med, 375, pp.1738~1748 (2016)
- Turner NC, "Palbociclib in hormone-receptor-positive advanced breast cancer", N Engl J Med, 373, pp.209~219 (2015)
- Sledge GW Jr, "MONARCH 2 : abemaciclib in combination with fulvestrant in women with HR+", HER2-advanced breast cancer who had progressed while receiving endocrine therapy, 2017, pp.35, 2875~2884
- Slamon DJ, "Phase III randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer : MONALEESA-3", J Clin Oncol, 36, pp.2465~2472 (2018)
- Tripathy D, "Ribociclib plus endocrine therapy for premenopausal women with hormone-receptor-positive, advanced breast cancer(MONALEESA-7) : a randomised phase 3 trial", Lancet Oncol, 19, pp.904~915 (2018)
- Sledge GW Jr, "The effect of abemaciclib plus fulvestrant on overall survival in hormone receptor-positive, ERBB2-negative breast cancer that progressed on endocrine therapy-MONARCH 2 : a randomized clinical trial", JAMA Oncol, 6, pp.116~124 (2020)
- Im SA, "Overall survival with ribociclib plus endocrine therapy in breast cancer", N Engl J Med, 381, pp.307~316 (2019)
- Slamon DJ, "Overall survival with ribociclib plus fulvestrant in advanced breast cancer", N Engl J Med, 382, pp.514~524 (2020)
- Baselga J, "Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer", N Engl J Med, 366, pp.520~529 (2012)
- Piccart M, "Everolimus plus exemestane for hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer : overall survival results from BOLERO-2dagger", Ann Oncol, 25, pp.2357~2362 (2014)
- Jansen VM, "Kinome-wide RNA interference screen reveals a role for PDK1 in acquired resistance to CDK4", 6 inhibition in ER-positive breast cancer, 2017, pp.77, 2488~2499
- Herrera-Abreu MT, "Early adaptation and acquired resistance to CDK4", 6 inhibition in estrogen receptor-positive breast cancer, 2016, pp.76, 2301~2313
- Yamamoto T, "Synergistic anti-cancer activity of CDK4", 6 inhibitor palbociclib and dual mTOR kinase inhibitor MLN0128 in pRb-expressing ER-negative breast cancer, 2019, pp.174, 615~625
- Michaloglou C, "Combined inhibition of mTOR and CDK4", 6 is required for optimal blockade of E2F function and long-term growth inhibition in estrogen receptor-positive breast cancer, 2018, pp.17, 908~920
- Cristofanilli M, "Fulvestrant plus palbociclib versus fulvestrant plus placebo for treatment of hormone-receptor-positive, HER2-negative metastatic breast cancer that progressed on previous endocrine therapy(PALOMA-3) : final analysis of the multicentre, double-blind, phase 3 randomised controlled trial", Lancet Oncol, 17, pp.425~439 (2016)
- Cardoso F, "5th ESO-ESMO international consensus guidelines for advanced breast cancer(ABC 5)", Ann Oncol, 31, pp.1623~1649 (2020)
- Chirila C, "Comparison of palbociclib in combination with letrozole or fulvestrant with endocrine therapies for advanced", metastatic breast cancer : network meta-analysis, 2017, pp.33, 1457~1466
- Cook MM, "Everolimus plus exemestane treatment in patients with metastatic hormone receptor-positive breast cancer previously treated with CDK4", 6 inhibitor therapy, 2021, pp.26, 101~106
- Dhakal A, "Outcome of everolimus-based therapy in hormone-receptor-positive metastatic breast cancer patients after progression on palbociclib", Breast Cancer(Auckl), 14, pp.1178223420944864~ (2020)
- Dhakal A, "Efficacy of palbociclib combinations in hormone receptor-positive metastatic breast cancer patients after prior rverolimus yreatment", Clin Breast Cancer, 18, pp.e1401~e1405 (2018)
- du Rusquec P, "Efficacy of palbociclib plus fulvestrant after everolimus in hormone receptor-positive metastatic breast cancer", Breast Cancer Res Treat, 168, pp.559~566 (2018)
- Kovac A, "Efficacy of palbociclib after everolimus in hormone receptor-positive, HER2-negative advanced breast cancer", J Clin Oncol, 38(15_Suppl), pp.e13030~ (2020)
- O’Leary B, "The genetic landscape and clonal evolution of breast cancer resistance to palbociclib plus fulvestrant in the PALOMA-3 trial", Cancer Discov, 8, pp.1390~1403 (2018)