Barriers to Adjuvant CDK4/6 Uptake and Evidence for Continued CDK4/6 Use in Metastatic HR Positive Breast Cancer

This segment explores why many eligible patients do not receive adjuvant CDK4/6 inhibitors and reviews data supporting continued CDK4/6 strategies in the metastatic setting. Panelists attribute the adjuvant uptake gap to clinician time constraints for detailed counseling, variable familiarity with evolving data, logistical burdens such as EKG access and frequent laboratory monitoring, concern about adding prolonged therapy after chemotherapy, and uncertainty about absolute versus individual benefit. Practical solutions include targeted education for community teams, streamlined monitoring workflows, patient education tools, and multidisciplinary support to reduce treatment fatigue and facilitate shared decision making.

For metastatic care, the panel summarizes modest but evolving evidence from studies that evaluated continuing or sequencing CDK4/6 inhibitors with novel agents. Prior exposure, endocrine sensitivity, and molecular profiling guide whether to continue CDK4/6 therapy or move to alternative targeted strategies. Real world and trial data are used to align practice with guideline recommendations while individualizing therapy based on prior response and toxicity risk.