Dr. Goetz on Treatment of Metastatic HR+ Breast Cancer

Matthew P. Goetz, MD, chair of the Breast Cancer Disease-Oriented Group and co-leader of the Women’s Cancer Center at the Mayo Clinic, discusses the treatment landscape for patients with metastatic hormone receptor (HR)—positive breast cancer.

The treatment paradigm in this space has evolved over the last few years, Goetz says. The current standard of care is to utilize an aromatase inhibitor (AI)—steroidal or nonsteroidal—along with a CDK4/6 inhibitor in the frontline setting. The commonly used AIs are anastrozole and letrozole. There are also data suggesting that fulvestrant can be combined with a CDK4/6 inhibitor. Moreover, for patients who have progressed on an AI in the adjuvant setting, the standard second-line option is fulvestrant with a CDK4/6 inhibitor.

There are currently 3 FDA-approved CDK4/6 inhibitors in this space: palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio). Approvals for these agents were based on positive data from the pivotal PALOMA-2, MONALEESA-2 and -7, and MONARCH 3 studies, respectively.