Raadpleeg ook literatuurlijst niet-toxische middelen en behandelingen specifiek bij borstkanker van arts-bioloog drs. Engelbert Valstar

6 augustus 2019: Bron: Clinical Breast Cancer

Zogeheten kinaseremmers zoals palbociclib, ribociclib en abemaciclib (zie ook in gerelateerde artikelen) aanvullend op hormoontherapie geven allemaal betere progressievrije ziekte en overleving voor borstkankerpatienten met hormoongevoelige borstkanker met alleen botuitzaaiingen. Echter elk van deze kinaseremmers geeft weer een ander bijwerkingenprofiel. 

Een meta-analyse van 6 gerandomiseerde studies concludeert dat het beste de behandelend arts vantevoren met de patient kan bespreken wat de bijwerkingen zouden kunnen zijn en samen met de patient kiezen welke kinaseremmer het beste past.

  • Selection of the CDK4/6 inhibitor should be based on expected toxicity, comorbidities, and patient preference.

Het volledige studierapport: First-line treatment for endocrine sensitive bone-only metastatic breast cancer: a systematic review and meta-analysis is niet gratis en moet voor worden betaald.

Ik kan dan ook geen details geven behalve dan het abstract:

First-line treatment for endocrine sensitive bone-only metastatic breast cancer: a systematic review and meta-analysis

A. Toss1,∗,'Correspondence information about the author A. Toss
M. Venturelli1
I. Sperduti2
E. Molinaro1
C. Isca1
E. Barbieri1
F. Piacentini1
C. Omarini1
L. Cortesi1
S. Cascinu1
L. Moscetti1

Abstract

PURPOSE

In the last decade, several clinical trials have investigated novel endocrine combinations for the first-line treatment of hormone receptor positive metastatic breast cancer. Nevertheless, the use of combinations for the first-line treatment of bone-only disease is widely discussed, due to its indolent natural history.

METHODS

We performed a comprehensive search of phase III randomized clinical trials published in the literature through September 2018. Our aim was to explore the role of the new endocrine approaches in bone-only metastatic breast cancer, suggesting a possible strategy for their selection. In particular, we evaluated the comparative risk of adverse event occurrence during these treatments.

RESULTS

A total of 6 studies were deemed suitable for the meta-analysis: the Monaleesa-2, Monaleesa-7, Monarch-3, Paloma-2, SWOG and the Alliance trials. Overall, the novel strategies were shown to improve progression free survival in bone-only disease [HR 0.65, 95%CI 0.49-0.86, p 0.003]. Combinations with CDKi improve PFS [HR 0.54, 95%CI 0.39-0.75, p <0.001] with acceptable toxicity profile. Abemaciclib is associated with increased anemia and gastro-intestinal toxicity (especially diarrhea), while palbociclib is associated with increased leucopenia (but not neutropenia) compared to the other compounds. Increased AST were reported for both ribociclib and abemaciclib.

CONCLUSIONS

The combination of cyclin-dependent kinase 4/6 inhibitors and endocrine therapy represents an effective and well-tolerated approach for first-line treatment in bone-only disease settings as well. Since no direct comparison between the three cyclin-dependent kinase 4/6 inhibitors is available, the selection of the most appropriate treatment should be based on toxicity profile and patient preferences and co-pathologies.


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