Ribociclib/ET versus Chemotherapy in Premenopausal Patients: RIGHT Choice

EP: 1.Standard-of-Care Treatment Approaches for HR+/HER2 Early Breast Cancer

EP: 2.Unmet Needs in Early-Stage HR+/HER2- Breast Cancer

EP: 3.Recent Data on Neoadjuvant Therapy in HR+/HER2- Breast Cancer

EP: 4.Circulating Tumor DNA as a Prognostic Marker in HR+/HER2- Breast Cancer

EP: 5.Recent Data on Adjuvant Therapies in HR+/HER2- Breast Cancer

EP: 6.Managing Abemaciclib-Associated Toxicities in HR+/HER2- Early Breast Cancer

EP: 7.Treatment and Dose Optimization in HR+/HER2- Early Breast Cancer

EP: 8.CDK4/6 Inhibitors in the Metastatic Breast Cancer Setting

EP: 9.Real-World Data on CDK4/6 Inhibitors in HR+/HER2- Metastatic Breast Cancer and Ongoing Trials

EP: 10.The SONIA Trial: Exploring CDK4/6 Inhibitor Efficacy in the First- and Second-Line Settings

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EP: 11.Ribociclib/ET versus Chemotherapy in Premenopausal Patients: RIGHT Choice

EP: 12.Potential Approaches to Treatment Switching in HR+/HER2- mBC

EP: 13.Addressing Disease Progression on ET: Data Updates and Ongoing Trials

EP: 14.HR+/HER2- Breast Cancer: Inhibiting the PI3K/AKT/mTOR Pathway

EP: 15.Biomarker Testing Practices in HR+/HER2- Breast Cancer

EP: 16.Data Updates on Sacituzumab Govitecan

EP: 17.Practical Considerations for ADC Selection in HR+/HER2- mBC

EP: 18.Looking Towards The Future of HR+/HER2- Breast Cancer

Transcript:

Komal Jhaveri, MD, FACP: One of the burning questions that we always have in the first line is [about] our young premenopausal women, and [how] they have aggressive tumor biology and don’t necessarily have the same outcomes that we would expect for others. Should we offer them chemotherapy? Can you walk us through the evidence about what you do [with] your patients and why?

Timothy Pluard, MD: That’s been an ongoing debate about somebody who has visceral involvement. Do they need [first-line] chemotherapy?… There’s no absolute definition of what’s visceral crisis or impending visceral crisis. There are some guidelines from the ABC [Advance Breast Cancer Global Alliance], but it’s really in the eyes of the treating physician as to what’s visceral crisis. Generally, you can say it’s impending organ failure, whether that’s hepatic failure or whether it’s respiratory failure from lung involvement.

So, the RIGHT Choice trial looked at the question of whether chemotherapy or ribociclib and endocrine therapy would be better in the first-line setting in patients with very aggressive visceral-involvement disease. The outcome of the trial showed that ribociclib and endocrine therapy had about a 12-month-longer progression-free survival. They both had the same overall response rate. So it’s clear that the combination of ribociclib and endocrine therapy is probably more effective than chemotherapy in those patients. It’s hard to envision the population that really needs chemotherapy in the first-line setting. Even the young patients, when they [were] analyzed and presented at ASCO [American Society of Clinical Oncology annual meeting] 2023, the patients under 40 compared to the overall population, they derived a similar benefit. So even in that population where we think the cancer is extremely aggressive, the ribociclib and endocrine therapy was still more effective.

Komal Jhaveri, MD, FACP: Yes, and the toxicity profile seems to be favoring the endocrine therapy arm as well with a CDK4/6 inhibitor. At some point I think patients are not going to be able to tolerate continuous chemotherapy, but I think they were able to tolerate the endocrine therapy. So yes, such an important question to be addressed for our patients there.

Transcript edited for clarity.

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