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3d

Did you know?

Hormone receptor-positive, HER2-negative metastatic breast cancer is the most common breast cancer subtype. Three Phase 3 RCTs (MONALEESA-2, MONALEESA-3, MONARCH 3) independently demonstrated that adding a CDK4/6 inhibitor to endocrine therapy (aromatase inhibitor or fulvestrant) approximately doubled median progression-free survival compared to endocrine therapy alone. Pooled analyses confirm PFS improvements of 10–12 months in the first-line setting, with OS benefits confirmed in the MONALEESA-3 and PALOMA-3 trials.

NCCN Guidelines
Discussion question

In your treatment approach for first-line HR+/HER2− metastatic breast cancer, how are you selecting among CDK4/6 inhibitor options — and how do patient comorbidities, tolerability profiles, and biomarkers like PIK3CA mutation status influence sequencing decisions?

  • 3d
    I am typically using CDK 4/6 inhibitors like Verzenio or Kisqali 1st line. Unless there is a contraindication for those, such as a GI issue. These have shown overall survival data and I have had good experiences with them.
  • 3d
    Ibrance has fallen out of Cat 1 rec's due to lack of OS. That leaves Ribo and Verzenio each with a different side effect profile. Those side effects tend to guide our approach and selection. PIK3CA agents tend to be reserved for second line use, assuming good glycemic control at baseline.

    I find it interesting that Europe sequences CDK 4/6 differently. The SONIA trial showed that reserving CDK4/6i to 2nd line therapy (AI first line) resulted in improved PS2