Prognostic characteristics in hormone receptor-positive advanced breast cancer and characterization of abemaciclib efficacy

CDK4 & 6 inhibitors have enhanced the effectiveness of endocrine therapy (ET) in patients with advanced breast cancer (ABC). This paper presents exploratory analyses examining patient and disease characteristics that may inform in whom and when abemaciclib should be initiated. MONARCH 2 and 3 enrolled women with HR+, HER2- ABC. In MONARCH 2, patients whose disease had progressed while receiving ET were administered fulvestrant+abemaciclib/placebo. In MONARCH 3, patients received a nonsteroidal aromatase inhibitor+abemaciclib/placebo as initial therapy for advanced disease. A combined analysis of the two studies was performed to determine significant prognostic factors. Efficacy results (PFS and ORR in patients with measurable disease) were examined for patient subgroups corresponding to each significant prognostic factor. Analysis of clinical factors confirmed the following to have prognostic value: bone-only disease, liver metastases, tumor grade, progesterone receptor status, performance status, treatment-free interval (TFI) from the end of adjuvant ET, and time from diagnosis to recurrence. Prognosis was poorer in patients with liver metastases, progesterone receptor-negative tumors, high grade tumors, or short TFI (20 months. These analyses identified prognostic factors and demonstrated that patients with poor prognostic factors derived the largest benefit from the addition of abemaciclib. Biomarkers: Prognostic factors indicate likely beneficiaries of cell cycle–blocking therapy A series of clinical factors may help identify those patients with hormone receptor-positive breast cancer who are most likely to benefit from a newly approved cell cycle–blocking drug. Angelo Di Leo from the Hospital of Prato, Italy, and colleagues retrospectively analyzed data from two phase III trials that evaluated the CDK4 & 6 inhibitor abemaciclib against a placebo administered in combination with either fulvestrant endocrine therapy or an aromatase inhibitor. Pooling the results, the researchers found that patients with certain indicators of poor prognosis—including liver metastases, progesterone receptor negativity, high-grad