EXPERT POINT OF VIEW: C. Kent Osborne, MD, and Joseph Sparano, MD

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“ONCOLOGISTS WANT to find drugs that will delay the use of chemotherapy, and cyclin-dependent kinase (CDK) 4/6 inhibitors provide that. These agents work better than chemotherapy and with less toxicity,” said press conference moderator C. Kent Osborne, MD, Director of the Duncan Cancer Center at Baylor College of Medicine in Houston. 

“This pooled analysis provides some reassurance about safety and, perhaps more important, about the efficacy of CDK 4/6 inhibitors in older women. In addition, it reinforces our concerns that there are more side effects in older women. The patients in clinical trials are not the same as the ones we see in clinical practice. We need to assess safety in patients who are less fit,” said Joseph Sparano, MD, of the Montefiore Medical Center, Bronx, New York. 

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Clinical Implications 

“AGE IS one of the factors we consider when selecting therapy. The patients we tend to treat with CDK 4/6 inhibitors added to endocrine therapy have a higher disease burden, are more fit, and tend to be younger. When we make a decision, the combination of age and fitness is important. One has to be careful to use CDK 4/6 inhibitors selectively. They are less toxic than chemotherapy, and now that they are available, we are using a lot less chemotherapy,” Dr. Sparano added. 

You need to consider other factors as well, he encouraged. “Are your patients living at home? What are their financial resources? Do these agents require additional visits?” 

Dr. Sparano continued: “As clinicians, we want to give our patients agents that are potentially useful. We have only about 2 years of experience with these agents. As we gain experience in younger, fitter patients, their use will expand to older patients.” ■

DISCLOSURE: Dr. Osborne reported no conflicts of interest. Dr. Sparano has served as a consultant for Pfizer, Novartis, and Eli Lilly. 

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