How to Give Subsequent Therapy for Older Patients With Breast Cancer on CDK4/6 Inhibitors
Treatment decisions for older adults after CDK4/6 inhibitors should be tailored, explained Courtney Moore, APRN, FNP-C, OCN.
When moving past the first line of treatment for older patients with hormone receptor (HR)–positive metastatic breast cancer due to adverse events (AEs) associated with CDK4/6 inhibitors, the patient’s whole clinical profile should be considered, said Courtney Moore, APRN, FNP-C, OCN.
After a Case-Based Roundtable with Oncology Nursing News, Moore explained that older patients often require a second line of treatment after CDK4/6 inhibitors due to toxicity. When opening that conversation with patients, Moore recommended that advanced practice providers (APPs) look beyond a generalization of what may be best for an entire patient population and instead focus on the individual patient’s needs.
This is especially pertinent for older patients, who may be more likely to have comorbidities or be taking other prescription drugs. For instance, if the patient has a history of atrial fibrillation, then a medication that prolongs QTc could be dangerous for that patient. Likewise, a patient with pre-existing gastrointestinal issues should not be given treatment that is likely to cause diarrhea, like abemaciclib (Verzenio).
Moore also recommended drawing on the interdisciplinary care team to gain a better understanding of the patient’s existing prescriptions and how drugs may interact.
Transcript
Where do we go from here? If we’re not seeing the benefits that we want to see, what next steps can we take in how we further treat the patient past that? This occurs a lot in our elderly population. What kind of modifications do we need to look towards to help prevent any of these toxic situations and best protect our patients? If they’re not tolerating treatment well, how do we go about these conversations about stopping treatment or possibly trying something different or withholding treatment altogether?
These patients tend to be on a lot of medications. They tend to have a lot of comorbidities already, so doing more patient-focused evaluations is very important. Medications can interact with other medications, so bringing in other disciplines, such as pharmacists, to help go through these lists of medications and how they can affect other medications and figure out a dosing schedule that is more helpful for the patient.
If you have a patient that has some gastrointestinal toxicities already, you don’t want to start them on a medication that has a high rate of diarrhea. You would want to choose a different medication. If you have an elderly patient that has atrial fibrillation, you’re not going to want to start them on a medication that can cause QTc prolongation. If you have a patient who is already on immunosuppression medications, you don’t want to choose medication that can increase the possibility of neutropenia for the patient.
The biggest thing we can all take away from this is to focus on the individual patients, rather than thinking, “This is the best medication for this population, period.” You have to drive the personalized care.
This transcript has been edited for clarity and conciseness.
