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Cyclin-dependent kinase 4/6 inhibitors combined with radiation therapy for patients with metastatic breast cancer
Ratoša, Ivica ...
The cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) represent the standard treatment for hormone receptor positive, human epidermal growth factor receptor 2 negative metastatic breast cancer ...(MBC). Data regarding toxicity safety profiles when combining CDK4/6i with palliative radiotherapy (RT) are lacking. Material and methods We undertook a review of 46 MBC patients on systemic treatment with CDK4/6i who underwent 62 metastases-directed RT. Clinical, laboratory, and RT treatment planning data were collected. Statistical analyses included a Student%s t-test, a paired sample t-test, and a logistic regression model. Results Thirty patients (65.2%) received palbociclib, 15 (32.6%) received ribociclib, and one patient received abemaciclib (2.2%). Median total (TD) prescribed RT dose was 20 Gy (range: 8%63 Gy). Sites of RT were bone (n=50; 80.7%), visceral (n=7; 11.3%), or brain metastases (n=3; 4.8%), as well as primary tumor of the breast (n=2; 3.2%). Overall, the rates of %G3 adverse events (AEs) were 6.5%, 4.3%, 15.2%, and 23.9% before the start of RT, during RT, two and six weeks after RT completion, respectively. A logistic regression analysis accounting for age, type of CDK4/6i, CDK4/6i suspension during RT, planning target volume, TD, and RT technique found that none of these factors had a negative effect on the cumulative toxicity of any grade. We found no correlation between dose distribution to at-risk organs and the development of AEs. Conclusions We observed a modest increase in the rates of %G3 AEs following RT. Nevertheless, serious AE incidence was similar to previous pivotal CDK4/6i trials.
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