Komal L. Jhaveri, MD
The explosion in the use of CDK4/6 inhibitors is unlikely to subside in the treatment of patients with ER-positive, HER2-negative breast cancer, as combination regimens continue to be explored as a means of overcoming acquired resistance.
State of the Science Summit™ on Breast Cancer, Jhaveri, a medical oncologist at Memorial Sloan Kettering Cancer Center, discussed the current and potential future uses of CDK4/6 inhibitors in breast cancer.
OncLive: How have CDK4/6 inhibitors impacted the treatment of patients with breast cancer?
: CDK4/6 inhibitors have certainly changed the landscape of the treatment for ER-positive, HER2-negative metastatic breast cancer. We now have 3 approved agents in this class. We have data to support their use in combination with endocrine therapy, both in the first- and second-line settings with unprecedented PFS benefits. While we don't have overall survival (OS) data, these PFS data have been very promising. PFS data justify—at least in most patients—combination therapies, barring the toxicity issues for individual patients. This is a class of agents that has been exciting for our patients, and it certainly has been an improvement in their outcomes when it comes to PFS.
What are your thoughts on combination strategies with CDK4/6 inhibitors?
There are many questions that we still have to get answers to. We're waiting for the OS data but having said that, these trials have not been powered for OS—they were powered for PFS. We may need a meta-analysis of these phase III trials to make any definitive conclusions about OS benefit. We know from treatment for HER2-positive breast cancer that patients who progress on anti-HER2 therapies continue to benefit from anti-HER2 therapy beyond progression. We don't have that data thus far for CDK4/6 inhibitors, but the question of whether there is a role for CDK4/6 inhibition beyond progression is being addressed in at least 3 clinical trials.
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