Metastatic HR+ breast cancer: subgroup OS benefit with CDK4/6 inhibitors plus ET

  • Schettini F & al.
  • J Natl Cancer Inst
  • 14 May 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A meta-analysis finds that CDK4/6 inhibitors+endocrine therapy (ET) yields improved OS in subgroups of patients with hormone receptor-positive (HR+)/HER2 metastatic breast cancer.

Why this matters

  • Authors recommend that CDK4/6 inhibition+ET should be "preferred over" ET alone for most clinically relevant subgroups, such as those with visceral metastases and older subgroups.

Study design

  • Meta-analysis of 6 phase 2/3 randomized controlled trials (RCTs; N=3421) of palbociclib, ribociclib, or abemaciclib+ET vs ET alone.
  • Funding: None.

Key results

  • With CDK4/6+ET vs ET alone, OS benefit (HRs; 95% CIs) was seen in patients:
    • Without visceral metastases: 0.68 (0.54-0.85). 
    • With visceral metastases: 0.76 (0.65-0.89).
    • With ≥3 metastatic sites: 0.75 (0.60-0.94).
    • With endocrine-resistant disease: 0.79 (0.67-0.93).
    • With endocrine-sensitive disease: 0.73 (0.61-0.88).
    • Aged
    • Aged ≥65 years: 0.71 (0.53-0.95).
    • Who were postmenopausal: 0.75 (0.66-0.86)
    • Who were pre/perimenopausal: 0.76 (0.60-0.96).
    • Who were chemotherapy-naive: 0.72 (0.55-0.93).

Limitations

  • Small number of trials.
  • Heterogeneity across trials.