Kubeczko Marcin, Jarząb Michał, Krzywon Aleksandra, Gräupner Donata, Polakiewicz-Gilowska Anna, Gabryś Dorota
Breast Cancer Center, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland.
Department of Biostatistics and Bioinformatics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland.
J Clin Med. 2023 Mar 4;12(5):2044. doi: 10.3390/jcm12052044.
Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy are the standard of care for HR-positive/HER2-negative advanced breast cancer patients. However, their role in the treatment of brain metastases is currently unclear. We retrospectively evaluate the results of patients (pts) with advanced breast cancer treated at our institution with CDK4/6i and radiotherapy to the brain. The primary endpoint was progression-free survival (PFS). Secondary endpoints were local control (LC) and severe toxicity. Among 371 pts treated with CDK4/6i, 24 pts (6.5%) received radiotherapy to the brain before (11 pts), during (6 pts), or after (7 pts) CDK4/6i treatment. Sixteen pts received ribociclib, six received palbociclib, and two received abemaciclib. Six- and twelve-month PFS was 76.5% (95% CI: 60.3-96.9) and 49.7% (95% CI: 31.7-77.9), respectively, whereas six- and twelve-month LC was 80.2% (95% CI: 58.7-100) and 68.8% (95% CI: 44.5-100), respectively. With a median follow-up of 9.5 months, no unexpected toxicity was observed. We conclude that treatment with both CDK4/6i and brain radiotherapy is feasible and should not increase the toxicity compared to brain radiotherapy or CDK4/6i alone. However, the small number of individuals treated concurrently limits the conclusions about the combination of both modalities, and the results from ongoing prospective clinical trials are eagerly awaited to understand both the toxicity profile and the clinical response fully.
细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）联合内分泌治疗是激素受体阳性/人表皮生长因子受体2阴性晚期乳腺癌患者的标准治疗方案。然而，它们在脑转移瘤治疗中的作用目前尚不清楚。我们回顾性评估了在我们机构接受CDK4/6i和脑部放疗的晚期乳腺癌患者的治疗结果。主要终点是无进展生存期（PFS）。次要终点是局部控制（LC）和严重毒性。在371例接受CDK4/6i治疗的患者中，24例（6.5%）在CDK4/6i治疗前（11例）、治疗期间（6例）或治疗后（7例）接受了脑部放疗。16例患者接受了瑞博西尼，6例接受了哌柏西利，2例接受了阿贝西利。6个月和12个月的PFS分别为76.5%（95%CI：60.3-96.9）和49.7%（95%CI：31.7-77.9），而6个月和12个月的LC分别为80.2%（95%CI：58.7-100）和68.8%（95%CI：44.5-100）。中位随访9.5个月，未观察到意外毒性。我们得出结论，CDK4/6i和脑部放疗联合治疗是可行的，与单独脑部放疗或CDK4/6i相比，不应增加毒性。然而，同时接受治疗的个体数量较少，限制了关于两种治疗方式联合应用的结论，我们急切期待正在进行的前瞻性临床试验结果，以全面了解毒性特征和临床反应。
