Use of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in older patients with ER-positive HER2-negative breast cancer: Young International Society of Geriatric Oncology review paper

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  • Nicolò Matteo Luca Battisti
    Department of Medicine – Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
  • Nienke De Glas
    Department of Medical Oncology, Leiden University Medical Center, Netherlands
  • Mina S. Sedrak
    Department of Medical Oncology & Therapeutics Research, City of Hope, USA
  • Kah Poh Loh
    Division of Hematology/Oncology, University of Rochester Medical Center, USA
  • Gabor Liposits
    Department of Oncology, Regionhospitalet Herning, Denmark
  • Enrique Soto-Perez-de-Celis
    Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
  • Jessica L. Krok-Schoen
    Division of Medical Dietetics and Health Sciences, The Ohio State University, Columbus, OH, USA
  • Ines B. Menjak
    Department of Medicine, University of Toronto, Toronto, Ontario, USA
  • Alistair Ring
    Department of Medicine, The Royal Marsden NHS Foundation Trust, UK

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<jats:p> The current standard of care for the management of estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer has been redefined by the introduction of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. Although adults aged 65 years and older account for the majority of patients with breast cancer, limited data are available about the age-specific dosing, tolerability, and benefit of CDK4/6 inhibitors in this growing population. Older adults are under-represented in clinical trials and as a result, clinicians are forced to extrapolate from findings in younger and healthier patients when making treatment decisions for older patients. In this article, we review the limited age-specific evidence on the efficacy, toxicity, and quality of life (QoL) outcomes associated with the use of CDK4/6 inhibitors in older adults. We also describe ongoing trials evaluating CDK4/6 inhibitors in the older population and highlight that only a minority of adjuvant and metastatic trials of CDK4/6 inhibitors in the general breast cancer population includes geriatric assessments. Finally, we propose potential strategies to help guide decision making for fit and unfit older patients based on disease endocrine sensitivity, the need for rapid response and geriatric assessment. </jats:p>

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