Management of toxicities associated with targeted therapies for HR-positive metastatic breast cancer: a multidisciplinary approach is the key to success

被引:33
作者
Cazzaniga, Marina Elena [1 ,2 ]
Danesi, Romano [3 ]
Girmenia, Corrado [4 ]
Invernizzi, Pietro [5 ,6 ]
Elvevi, Alessandra [5 ,6 ]
Uguccioni, Massimo [7 ]
Gila, Monica Perez [8 ]
Amaducci, Laura
Atzori, Francesco
Blasi, Livio
Butti, Chiara
Collova, Elena
De Conciliis, Enrico
Fabi, Alessandra
Febbraro, Antonio
Garrone, Ornella
Gianni, Lorenzo
Giotta, Francesco
La Verde, Nicla
Michelotti, Andrea
Palumbo, Raffaella
Paris, Ida
Pistelli, Mirco
Pizzuti, Laura
Rubino, Daniela
Valerio, Maria Rosaria
Zustovich, Fable
机构
[1] Dept Med Oncol, Via Pergolesi 33, I-20900 Monza, Italy
[2] Phase 1 Res Ctr ASST Monza, Via Pergolesi 33, I-20900 Monza, Italy
[3] Univ Pisa, Dept Clin & Expt Med, Unit Clin Pharmacol & Pharmacogenet, Pisa, Italy
[4] Sapienza Univ, Dept Hematol Oncol & Dermatol, Azienda Policlin Umberto I, Rome, Italy
[5] Univ Milano Bicocca, Div Gastroenterol, Dept Med & Surg, Monza, Italy
[6] Univ Milano Bicocca, Ctr Autoimmune Liver Dis, Dept Med & Surg, Monza, Italy
[7] San Camillo Hosp, Cardiol 1 CCU, Rome, Italy
[8] Oncol Med ASST Monza San Gerardo, HERMIONE Network, Monza, MB, Italy
关键词
Abemaciclib; Advanced breast cancer; Everolimus; Neutropenia; Palbociclib; Ribociclib; EVEROLIMUS PLUS EXEMESTANE; PHASE-I; DRUG-INTERACTIONS; ELDERLY-PATIENTS; SAFETY; RIBOCICLIB; WOMEN; ABEMACICLIB; PALBOCICLIB; FULVESTRANT;
D O I
10.1007/s10549-019-05261-5
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PurposeAgents targeting HR-positive, HER2-negative locally advanced or metastatic breast cancer have improved patient outcomes compared with conventional single-agent endocrine therapy. Currently, approved targeted agents include everolimus and three CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib. Unlike the well-characterized and easily manageable safety profile of endocrine therapies, adverse events associated with targeted therapies are complex and potentially severe. Their prompt recognition and treatment, crucial for prolonged endocrine sensitivity and survival, may be challenging and requires a multidisciplinary effort and a good knowledge of drug interactions.MethodsWe reviewed the current evidence on the drug safety of targeted agents for metastatic breast cancer currently used in clinical practice in Italy, supported by the clinical experience of Italian oncologists with expertise in the field.ResultsAll oncologists had used CDK4/6 inhibitors in clinical practice and/or within a clinical trial. The clinical management of toxicities, including dose adjustments, treatment interruptions, and concerns regarding special populations is discussed, and the management of relevant adverse events, related to individual agents and class-specific, toxicities is reviewed. Hematologic toxicities have the greatest impact on clinical management of the disease and on patients. Although toxicities associated with the new treatments result in more visits to the physician and more time and attention with patients, they are manageable, with no need for the oncologist to consult with specialist physicians.ConclusionsBased on the available evidence and current guidelines, we propose a series of practical recommendations for multidisciplinary clinical management of the various toxicities associated with the addition of targeted agents to endocrine therapy.
引用
收藏
页码:483 / 494
页数:12
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