Dr Conlin on CDK4/6 Inhibitor Sequencing and QOL in Breast Cancer

Alison K. Conlin, MD, medical oncologist, Providence Cancer Institute Franz Clinic, discusses unanswered questions regarding the use of CDK4/6 inhibitors after prior progression on CDK4/6 inhibitors and quality of life (QOL) considerations in patients with breast cancer.

Dr Conlin on CDK4/6 Inhibitor Sequencing in HR+/HER2– Breast Cancer

Current clinical trial results pose conflicting data regarding optimal CDK4/6 inhibitor sequencing in patients with hormone receptor (HR)–positive, HER2-negative breast cancer, Conlin says. The efficacy and safety of using additional CDK4/6 inhibitors in patients with this disease who have progressed on a prior CDK4/6 inhibitor remains unknown, Conlin explains. Providence Cancer Institute plans to conduct further research to address this question, Conlin notes.

Continuing CDK4/6 inhibition after progression on first-line CDK4/6 inhibitors is beneficial for some patients, but may not be the most effective or tolerable treatment strategy in all patients with HR-positive, HER2-negative disease, Conlin emphasizes. This decision should be informed by each patient’s progression level and ability to tolerate further CDK4/6 inhibition, according to Conlin.

Further data beyond phase 2 single-arm clinical trial findings are needed to determine the feasibility of sequencing CDK4/6 inhibitors upon progression, Conlin says. Until those research efforts read out, most patients with HR-positive, HER2-negative breast cancer should receive a first-line CDK4/6 inhibitor followed by another type of targeted therapy, Conlin explains.

Dr Conlin on The Importance of QOL Considerations in Breast Cancer

QOL is important to patients receiving breast cancer treatment, and the development of treatment plans should include conversations with each patient about their preferences and challenges, such as their ability or willingness to regularly come into the clinic to receive treatment, Conlin emphasizes. Other patients may want to avoid adverse effects (AEs) such as nausea or hair loss, which can affect their daily life, Conlin notes.

Efforts to improve patient QOL are embedded into oncology research and practice, as patients with cancer must often make sacrifices that affect their happiness and comfort when receiving treatment, according to Conlin. Even clinical trials that do not directly evaluate QOL outcomes can contribute to improved QOL for patients if they show efficacy and tolerability benefits with regimens that are easier to take and associated with fewer toxicities than standard treatments, Conlin explains. Shared decision making should be part of all treatment conversations with patients, Conlin concludes.