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SABCS 2017: The latest in CDK inhibition in breast cancer

5th - 9th Dec 2017

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Published: 10.12.17
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Prof Nadia Harbeck, Dr Mark Beresford, Dr Shom Goel and Dr Sara Hurvitz

Professor Nadia Harbeck Chairs an expert discussion on the latest in CDK inhibition in breast cancer and what this means for patients for ecancer at the 40th annual San Antonio Breast Cancer Symposium. Professor Harbeck is joined by Dr Mark Beresford, Dr Shom Goel and Dr Sara Hurvitz.


The panel started by discussing the positive CDK 4/6 inhibitor data that was released during 2017, in particular for patients with metastatic breast cancer, in the 1st line setting, who were not previously exposed to endocrine treatment, and how ribociclib and palbociclib are now available in the U.K. following their recent approval in Europe.

Dr Hurvitz discussed the phase II neoMONARCH study, which looked at neo-adjuvant use of abemaciclib. In the first two weeks patients received abemaciclib /- anastrozole, and following a biopsy both drugs were prescribed until the time of surgery. The final clinical data shows that there was a significant reduction in Ki67 in over 90% of patients who received abemaciclib base therapy, compared to anastrozole. Studies like neoMONARCH and POETIC, are useful as they allow clinicians to run smaller clinical trials, with fewer patients, in a shorter period of time to test the efficacy of these new agents for breast cancer management.

Professor Harbeck discussed the pre-menopausal study, MONALEESA-7, in the 1st line. The findings showed that there was a substantial increase in Progression-Free Survival to 23.8 months for women who received ribociclib in combination with either tamoxifen or a nonsteroidal aromatase inhibitor (AI) and goserelin, compared with 13.0 months for those who received the standard endocrine therapy plus placebo, with a hazard ratio similar or slightly lower than that seen in post-menopausal women. The data was well received by all panelist and they stated that a study of this size has not been seen in over 15 years in this group of young pre-menopausal women.

The panel then discussed the similarities of the approved CDK 4/6 inhibitors, ribociclib, palbociclib and abemaciclib, with abemaciclib offering a different toxicity profile, due to its chemical structure, resulting in less neutropenia but more diarrhoea, and a higher response rate when prescribed as a monotherapy, which was documented in the MONARCH-1 study.

The conversation the turned to patient eligibility and the panel agreed that it was prudent to offer the best possible treatment first to patients, where possible, due to the proven response rates seen with CDK 4/6 inhibitors. This point was of particular interest to Dr Beresford as ribociclib and palbocilcib are not approved for 2nd line use in the U.K., and therefore will not be an option for those who are treated with hormone therapy, for example, as an initial option. The panel also reiterated the importance of considering CDK 4/6 inhibitors as a 1st line option to avoid the over use of chemotherapy; a strategy that was backed up by the PALOMA-1 study that showed treatment with a CDK 4/6 inhibitor delayed the time until a patient received subsequent chemotherapy treatment.

The panel finished the talk by discussing the need to identify a robust bio-marker to further identify patient eligibility, how to manage the side effect profile of treatments, and what they were looking forward to seeing in 2018 e.g. how will HER2 and triple-negative patients respond to combination therapy, and what we will see from a bio-marker perspective and adjuvant trials.

Supported by a grant from Pfizer Inc.

Previous conferences: highlights



Founding partners

European Cancer Organisation European Institute of Oncology

Founding Charities

Foundazione Umberto Veronesi Fondazione IEO Swiss Bridge

Published by

Cancer Intelligence