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Eligibility for Adjuvant Cyclin-Dependent Kinase 4/6 Inhibitors in Endocrine Receptor-Positive and HER2-Negative Early Breast Cancer by Age and Type of Surgery
by
, , ,
Gilles Houvenaeghel
1,*
,
Jean-Marc Classe
2
,
Marie-Pierre Chauvet
3,
Pierre-Emmanuel Colombo
4,
Eva Jouve
5,
Fabien Reyal
6,
Emile Daraï
7,
Roman Rouzier
8,
Christelle Faure-Virelizier
9,
Pierre Gimbergues
10,
Charles Coutant
11,
Chafika Mazouni
12,
Anne-Sophie Azuar
13,
Marc Martino
14,
Catherine Bouteille
15,
Monique Cohen
15 and
Alexandre de Nonneville
16,* 1
Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, 13009 Marseille, France
2
Institut René Gauducheau, Site Hospitalier Nord, 44800 St. Herblain, France
3
Centre Oscar Lambret, 3 Rue Frédéric Combenal, 59000 Lille, France
4
Institut du Cancer de Montpellier, 31 Rue de la Croix Verte, 34090 Montpellier, France
5
IUCT Oncopole, 1 Av. Irène Joliot-Curie, 31100 Toulouse, France
6
Institut Curie, 26 Rue d’Ulm, 75248 Paris Cedex 05, France
7
Hôpital Tenon, AP-HP, 4 Rue de la Chine, 75020 Paris, France
8
Centre François Baclesse, 3 Av. du Général Harris, 14000 Caen, France
9
Centre Léon Bérard, 28 Rue Laennec, 69008 Lyon, France
10
Centre Jean Perrin, 58 Rue Montalembert, 63000 Clermont Ferrand, France
11
Centre Georges François Leclerc, 1 Rue du Professeur Marion, 21000 Dijon, France
12
Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
13
Hôpital de Grasse, Chemin de Clavary, 06130 Grasse, France
14
Hôpital Saint Joseph, 26 Bd de Louvain, 13008 Marseille, France
15
Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, 13009 Marseille, France
16
Aix-Marseille Univ, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, 13009 Marseille, France
*
Authors to whom correspondence should be addressed.
Cancers 2024, 16(19), 3317; https://doi.org/10.3390/cancers16193317 (registering DOI)
Submission received: 3 September 2024
/
Revised: 25 September 2024
/
Accepted: 26 September 2024
/
Published: 27 September 2024
(This article belongs to the Section Cancer Biomarkers)
Simple Summary
Improved outcomes have been reported with adjuvant treatment combining cyclin-dependent kinase 4/6 inhibitors with endocrine therapy, in high-risk patients with ER-positive and HER2-negative breast cancer, regardless of age. In this real-world data analysis, MonarchE and NataLEE high-risk patients accounted for 9.5% and 33% of patients undergoing upfront surgery, respectively. Significantly higher eligibility rates were observed in patients who underwent a mastectomy, >70 years and ≤40 years for adjuvant abemaciclib and ribociclib, and in patients >80 years for ribociclib. A higher discontinuation rate for abemaciclib was reported in patients ≥65 years and it can be assumed that discontinuation rates may increase with more older patients. If the results of the NataLEE trial translate into clinical practice, the number of patients potentially eligible for adjuvant CDK4/6 inhibitors may increase, especially in the elderly population.
Abstract
Background: Despite early diagnosis, approximately 20% of patients with ER-positive and HER2-negative breast cancer (BC) will experience disease recurrence. Improved survival has been reported with adjuvant treatment combining cyclin-dependent kinase 4/6 inhibitors with endocrine therapy, in high-risk patients with ER-positive and HER2-negative BC, regardless of age. Older patients have higher rates of ER-positive/HER2-negative BC than younger patients. Methods: In this real-world data analysis, MonarchE and NataLEE high-risk patients accounted for 9.5% and 33% of patients undergoing upfront surgery, respectively. Significantly higher eligibility rates were observed in patients who underwent a mastectomy, >70 years and ≤40 years for adjuvant abemaciclib and ribociclib, and in patients >80 years for ribociclib. Results: Eligibility rates in patients ≤40 years and >80 years who underwent mastectomy were 27.8% and 24.7% for abemaciclib, respectively, and 56.6% and 65.2% for ribociclib, respectively. A higher discontinuation rate for abemaciclib was reported in patients aged ≥65 years and it can be assumed that discontinuation rates may increase in even older patients. Conclusions: If the results of the NataLEE trial translate into clinical practice, the number of patients potentially eligible for adjuvant CDK4/6 inhibitors may increase, especially in the elderly population.
Keywords:
abemaciclib; ribociclib; age; breast cancer; sentinel lymph nodes
