CDK-4/6 inhibitors with endocrine treatment for metastatic breast cancer
Dr Sitna Mwanzi - Kenyatta National Hospital, Nairobi, Kenya
What is your experience working with CDK-4/6 inhibitors in combination with endocrine treatment for metastatic breast cancer in Kenya?
As you know, this therapy has been in the market since probably 2015 when palbociclib was the first cyclin-dependent kinase inhibitor that was approved in the second-line setting for metastatic breast cancer. The challenge has been when we have drug development in the West it takes quite a bit of time for us to get the molecule in our country. So the first molecule arrived in our country in 2018 so the use has been delayed compared to the use in other settings.
It's an oral treatment which is quite good for patients and now approved both in the first-line setting and the second-line setting for metastatic breast cancer that is hormone positive. So our experience, we were just trying to highlight our experience in terms of do we need to… Let me just go back and say, a lot of the studies that were done were not inclusive of patients of Black African descent. So we need to understand that we are using a treatment that hasn’t been tried in our population and that’s why it’s important to have real-world data.
So in our work we wanted to highlight is it something that we are seeing causing a good effect on our patients? Are they getting the same level of progression free survival as compared to what the studies are showing? One of the main side effects of the drug is neutropenia and are we seeing a lot more neutropenia and do we need to do more dose reductions? And that’s exactly what we found – it’s efficacious but over 90% of our patients need a dose reduction because of cytopenia which is higher than what was reported in the studies.
What are the next steps in this research?
The next step, our study was very small so we just looked at 20 or so patients and we have already talked to our colleagues within Nairobi who are oncologists and giving this treatment. So just expanding from the pilot phase to include more oncologists within Kenya and within our region which is East Africa, just to see whether their experiences are similar in terms of efficacy of the treatment and what are some of the toxicities that our patients are having.