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HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review

The approval of CDK4/6 inhibitors has dramatically improved care for the treatment of HR+/HER2– advanced breast cancer, but navigating the rapidly-expanding treatment evidence base is challenging. In this narrative review, we provide best-practice recommendations for the first-line treatment of HR+/...

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Autores principales: Jerzak, Katarzyna J., Bouganim, Nathaniel, Brezden-Masley, Christine, Edwards, Scott, Gelmon, Karen, Henning, Jan-Willem, Hilton, John F., Sehdev, Sandeep
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10297170/
https://www.ncbi.nlm.nih.gov/pubmed/37366894
http://dx.doi.org/10.3390/curroncol30060411
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author Jerzak, Katarzyna J.
Bouganim, Nathaniel
Brezden-Masley, Christine
Edwards, Scott
Gelmon, Karen
Henning, Jan-Willem
Hilton, John F.
Sehdev, Sandeep
author_facet Jerzak, Katarzyna J.
Bouganim, Nathaniel
Brezden-Masley, Christine
Edwards, Scott
Gelmon, Karen
Henning, Jan-Willem
Hilton, John F.
Sehdev, Sandeep
author_sort Jerzak, Katarzyna J.
collection PubMed
description The approval of CDK4/6 inhibitors has dramatically improved care for the treatment of HR+/HER2– advanced breast cancer, but navigating the rapidly-expanding treatment evidence base is challenging. In this narrative review, we provide best-practice recommendations for the first-line treatment of HR+/HER2– advanced breast cancer in Canada based on relevant literature, clinical guidelines, and our own clinical experience. Due to statistically significant improvements in overall survival and progression-free survival, ribociclib + aromatase inhibitor is our preferred first-line treatment for de novo advanced disease or relapse ≥12 months after completion of adjuvant endocrine therapy and ribociclib or abemaciclib + fulvestrant is our preferred first-line treatment for patients experiencing early relapse. Abemaciclib or palbociclib may be used when alternatives to ribociclib are needed, and endocrine therapy can be used alone in the case of contraindication to CDK4/6 inhibitors or limited life expectancy. Considerations for special populations—including frail and fit elderly patients, as well as those with visceral disease, brain metastases, and oligometastatic disease—are also explored. For monitoring, we recommend an approach across CDK4/6 inhibitors. For mutational testing, we recommend routinely performing ER/PR/HER2 testing to confirm the subtype of advanced disease at the time of progression and to consider ESR1 and PIK3CA testing for select patients. Where possible, engage a multidisciplinary care team to apply evidence in a patient-centric manner.
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spelling pubmed-102971702023-06-28 HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review Jerzak, Katarzyna J. Bouganim, Nathaniel Brezden-Masley, Christine Edwards, Scott Gelmon, Karen Henning, Jan-Willem Hilton, John F. Sehdev, Sandeep Curr Oncol Review The approval of CDK4/6 inhibitors has dramatically improved care for the treatment of HR+/HER2– advanced breast cancer, but navigating the rapidly-expanding treatment evidence base is challenging. In this narrative review, we provide best-practice recommendations for the first-line treatment of HR+/HER2– advanced breast cancer in Canada based on relevant literature, clinical guidelines, and our own clinical experience. Due to statistically significant improvements in overall survival and progression-free survival, ribociclib + aromatase inhibitor is our preferred first-line treatment for de novo advanced disease or relapse ≥12 months after completion of adjuvant endocrine therapy and ribociclib or abemaciclib + fulvestrant is our preferred first-line treatment for patients experiencing early relapse. Abemaciclib or palbociclib may be used when alternatives to ribociclib are needed, and endocrine therapy can be used alone in the case of contraindication to CDK4/6 inhibitors or limited life expectancy. Considerations for special populations—including frail and fit elderly patients, as well as those with visceral disease, brain metastases, and oligometastatic disease—are also explored. For monitoring, we recommend an approach across CDK4/6 inhibitors. For mutational testing, we recommend routinely performing ER/PR/HER2 testing to confirm the subtype of advanced disease at the time of progression and to consider ESR1 and PIK3CA testing for select patients. Where possible, engage a multidisciplinary care team to apply evidence in a patient-centric manner. MDPI 2023-06-02 /pmc/articles/PMC10297170/ /pubmed/37366894 http://dx.doi.org/10.3390/curroncol30060411 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Jerzak, Katarzyna J.
Bouganim, Nathaniel
Brezden-Masley, Christine
Edwards, Scott
Gelmon, Karen
Henning, Jan-Willem
Hilton, John F.
Sehdev, Sandeep
HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review
title HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review
title_full HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review
title_fullStr HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review
title_full_unstemmed HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review
title_short HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review
title_sort hr+/her2– advanced breast cancer treatment in the first-line setting: expert review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10297170/
https://www.ncbi.nlm.nih.gov/pubmed/37366894
http://dx.doi.org/10.3390/curroncol30060411
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