CDK4/6 Inhibition Customizes Frontline HR+, HER2- mBC Treatment

Because of the selection of CDK4/6 inhibitors now available in the first-line setting for patients with hormone receptor (HR)-positive, HER2-negative metastatic breast cancer, providers now have the option to tailor treatment to patients’ preferences and history, according to Kimberly Podsada, BSN, RN, MSN, NP-C, CNS.

In an interview with Oncology Nursing News following a Case-Based Roundtable discussion with fellow oncology advanced practice providers (APPs), Podsada explained that a patient’s prior experiences such as suboptimal liver function, nausea during pregnancy, or rheumatoid arthritis could impact a provider’s choice of which treatment to select in the front line, including abemaciclib (Verzenio), ribociclib (Kisqali), and palbociclib (Ibrance).

Podsada, a nurse practitioner at the University of California San Diego, emphasized that these options allow providers to make a more personalized and informed care decision with patients.

Transcript

We have the luxury now of having a variety of CDK4/6 inhibitors to choose from, and we really can tailor our choice based on the patient’s comorbidities, lifestyle, obstacles, [and] preferences, so we can really look at the whole picture of the patient. How are their kidneys functioning? How is their liver functioning? What sort of support services do they have? Are they going to be able to get to the clinic?

There are our first-line CDK4/6 inhibitors, and all 3 have been approved in that setting. Yet, again, there is provider preference, and now I think we can really look at the individual as well and make that decision based on them and their preferences.

One of the things I like to assess about my patients are the baseline issues that they’re already bringing into clinic: “I already have a sensitive gut.” “Oh, I had really bad nausea with pregnancy.” “I’m already on an immunosuppressant for my rheumatoid arthritis.” All of these things I’d be looking at and making a decision.

If someone’s coming off of chemotherapy, let’s say, and they still have [gastrointestinal] issues and they were never able to get on top of their diarrhea, am I going to prescribe abemaciclib? I don’t know. But if someone is already neutropenic because of previous therapies or other medications, am I going to prescribe [palbociclib] or [ribociclib] because of the risk of neutropenia?

It’s a very detailed conversation with the individual and looking at the whole person honestly and thinking about that, not just having your personal preference of, “This is the drug I always want to prescribe,” but looking at the patient and going, “How is this medication going to impact my patient’s quality of life and ability to get the best care I want to give her or him?”

This transcript has been edited for clarity and conciseness.