ABSTRACT
INTRODUCTION: Cyclin-dependent kinases 4/6 inhibitors (CDK 4/6i) combined with endocrine therapy have become the gold standard in hormone receptor-positive (HR +) HER2-negative (HER2-) metastatic breast cancer (MBC). However, there is a significant lack of data regarding the efficacy and safety of these treatments in elderly patients. We present the results of a real-world data (RWD) cohort stratified by age at treatment initiation (≥ 70 years compared to patients < 70 years). METHODS: Clinico-pathological data of HR + HER2- MBC patients who were candidates for CDK4/6i therapy between January 2017 and December 2020 at the Institut Català d'Oncologia (Spain) were retrospectively collected. The primary goal was to assess Progression-Free Survival (PFS), Overall Survival (OS), and safety outcomes within this patient population. RESULTS: A total of 274 patients with MBC who received CDK4/6i treatment were included in the study. Among them, 84 patients (30.8%) were aged ≥ 70 years, with a mean age of 75, while 190 patients (69.2%) were under the age of 70, with a mean age of 55.7 years. The most frequently observed grade 3-4 toxicity was neutropenia, with similar rates in both the < 70 group (43.9%) and the ≥ 70 group (47.9%) (p = 0.728). The median Progression-Free Survival (mPFS) for the first-line CDK4/6i treatment was 22 months (95% CI, 15.4-39.8) in the < 70 group and 20.8 months (95% CI 11.2-NR) in the ≥ 70 group (p = 0.67). Similarly, the median PFS for the second-line CDK4/6i treatment was 10.4 months (95% CI, 7.4-15.1) and 7.1 months (95% CI 4.4-21.3) (p = 0.79), respectively. Median overall survival (mOS) was not reached either for the first- and second-line treatment. CONCLUSIONS: Our RWD suggests that elderly patients, when compared to those under 70, experience similar survival outcomes and exhibit comparable tolerance for CDK4/6i therapy.
Subject(s)
Breast Neoplasms , Cyclin-Dependent Kinase 4 , Cyclin-Dependent Kinase 6 , Progression-Free Survival , Protein Kinase Inhibitors , Receptor, ErbB-2 , Receptors, Progesterone , Humans , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms/mortality , Breast Neoplasms/metabolism , Aged , Cyclin-Dependent Kinase 4/antagonists & inhibitors , Cyclin-Dependent Kinase 6/antagonists & inhibitors , Receptor, ErbB-2/metabolism , Middle Aged , Retrospective Studies , Protein Kinase Inhibitors/therapeutic use , Protein Kinase Inhibitors/adverse effects , Aged, 80 and over , Receptors, Progesterone/metabolism , Receptors, Estrogen/metabolism , Adult , Age Factors , Piperazines/therapeutic useABSTRACT
Alternative dosage regimens for some anticancer therapies have been proposed in the midst of the SARS-COV-2 pandemic in order to protect the patients from attending to health care facilities. Flat-dosing of several immune-checkpoint inhibitors (ICIs), including nivolumab, have been established. Although generally well tolerated with no new safety signals, new dosages can associate novel individual toxicities. As the use of ICIs is increasing in cancer patients, the present case report is a reminder for clinicians of potential novel toxicities, as well as the need for an interdisciplinary approach for their recognition and treatment. We report the occurrence of a severe neurologic toxicity in a patient with non-small cell lung cancer (NSCLC) who developed should be changed to which occurred after two doses of extended higher interval flat-dose nivolumab despite two years of clinical stability on prior nivolumab regimen. Patient developed fever, language impairment and altered mental status. The work-up tests excluded other potential causes and the most likely diagnosis was meningoencephalitis. Fortunately, with medical treatment, which consisted of high dose steroids, the patient recovered to his baseline situation and symptoms did not recurred, even though nivolumab was resumed. Alternate ICI regimens may have unique immune-related adverse event profiles.
ABSTRACT
En este estudio se evaluaron las biotransformaciones realizadas por el hongo fitopatógeno Colletotrichum acutatum, sobre los sustratos 2-feniletanol 1 y acetofenona 2; los procesos se realizaron en el medio de cultivo líquido Czapeck-Dox a temperatura promedio de 24 oC, humedad relativa entre 45 y 60%, y agitación a 150 rpm en un agitador orbital tipo shaker. En la biotransformación a partir del sustrato 1 se obtuvieron los productos metabólicos 1-fenil-1,2-etanodiol 3, (2-metoxietil) benceno 4 y acetato de 2-feniletilo 5, y desde el sustrato 2 los compuestos 1-fenil-1,2-etanodiol 3, 1-feniletanol 6 y 2-feniletanol 1. Los productos de la transformación microbiana se identificaron mediante cromatografía de gases acoplada a espectrometría de masas (CG-EM), y resonancia magnética nuclear de protón y carbono (RMN 1H y 13C). Se observó una tendencia marcada del patógeno a producir hidroxilaciones sobre el sustituyente del anillo aromático; igualmente, tiene la capacidad de reducir el grupo carbonilo y esterificar los grupos hidroxilo de alcoholes primarios. Se discute una posible ruta metabólica para la transformación de los sustratos.
The microbial transformation of 2-phenilethanol 1 and acetophenone 2 was investigated using the plant pathogenic fungus Colletotrichum acutatum; the process was carried out in liquid media culture Czapeck-Dox at an average temperature of 24 oC, a relative humidity between 45% and 60% and with agitation in a shaker at 150 rpm. The biotransformation of the substrate 1 produced the metabolic products 1-phenyl-1,2-ethanediol 3, (2- methoxyethyl)benzen 4 and 2-phenylethyl acetate 5, and from substrate 2 were obtained the compounds 1-phenyl- 1,2-ethanediol 3, 1-phenylethanol 6 and 2-phenylethanol 1. The structures of metabolic products were determined by gas chromatography coupled with mass spectrometry (GC-MS) and nuclear magnetic resonance of proton and of carbon (1H and 13C NMR). The process has a strong tendency of the pathogen to produce hydroxylations on the substituents attached to the aromatic ring. Additionally, C. acutatum was effective to reduce the carbonyl group and produce esterification reactions in the hydroxyl groups from primary alcohols. The metabolic pathway of both substrates is discussed.
Neste estudo foi analisada as biotransformaçoes feitas pelo fungos fitopatogênico Colletotrichum acutatum, nos substratos 2-feniletanol 1 e acetofenona 2; os processos forem feitos no meio de cultura Czapeck-Dox a uma temperatura média de 24 °C, umidade relativa entre 45 e 60% e agitação 150 rpm em um agitador orbital tipo shaker. Na biotransformaçao do substrato 1 é obtido os produtos metabólicos 1-fenil-1,2-etanodiol 3, (2-metoxietil) benceno 4 e acetato de 2-feniletilo 5, e do substrato 2 os compostos 1-fenil- 1,2-etanodiol 3, 1-feniletanol 6 e 2- feniletanol 1. Os produtos da transformação microbial forem identificados por meio do cromatografia de gás acoplada ao espectrometria da massas (CG-EM) e ressonância magnética nuclear de hidrogênio e de carbono (RMN 1H e 13C). Uma tendência marcada do patógeno é observada para produzir hidroxilaçoes na cadeia lateral do anel aromático; também tem a capacidade de reduzir ao grupo carbonilo e esterificar dos grupos hidroxilo da função álcool primária. Uma rota metabólica possível para a transformação das substratos é discutida.
