Refining Risk Assessment for Adjuvant CDK4/6 Inhibitors beyond Trial Inclusion Criteria: Integrating Recurrence Score and Endocrine Responsiveness according to ADAPT - PubMed
6 hours ago
- #breast cancer
- #risk assessment
- #CDK4/6 inhibitors
- The study focuses on refining risk assessment for adjuvant CDK4/6 inhibitors in HR+/HER2- high-risk early breast cancer (eBC) beyond trial inclusion criteria.
- It integrates recurrence score (RS) and endocrine responsiveness based on the WSG-ADAPT-HR+/HER2- trial.
- Key trials referenced include NATALEE and monarchE, which showed improved survival with CDK4/6 inhibitors added to endocrine therapy (ET), though benefits vary by prognostic factors.
- Patients were categorized into low, intermediate, and high-risk groups based on NATALEE and monarchE criteria.
- Findings indicate that intermediate-risk patients (meeting NATALEE but not monarchE criteria) had slightly inferior outcomes compared to low-risk patients but could still benefit from CDK4/6 inhibitors.
- ET-response evaluation (Ki67 post-ET ≤10%) was crucial in refining prognosis and guiding treatment decisions.
- 5-year invasive disease-free survival (iDFS) and distant DFS (dDFS) rates were highest in low-risk groups and decreased progressively in intermediate and high-risk groups.
- The study suggests an absolute benefit of ~2% fewer dDFS events in intermediate-risk patients if treated with ribociclib, based on a hazard ratio of 0.7.
- The research underscores the importance of ET-response in shared decision-making for intermediate-risk patients.