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The impact of ethnicity on efficacy and toxicity of cyclin D kinase 4/6 inhibitors in advanced breast cancer: a meta-analysis

Breast cancer research and treatment, 2019-02, Vol.174 (1), p.271-278 [Peer Reviewed Journal]

Springer Science+Business Media, LLC, part of Springer Nature 2018 ;COPYRIGHT 2019 Springer ;Breast Cancer Research and Treatment is a copyright of Springer, (2018). All Rights Reserved. ;ISSN: 0167-6806 ;EISSN: 1573-7217 ;DOI: 10.1007/s10549-018-5054-x ;PMID: 30465154

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  • Title:
    The impact of ethnicity on efficacy and toxicity of cyclin D kinase 4/6 inhibitors in advanced breast cancer: a meta-analysis
  • Author: Lee, Kirsty Wai Chung ; Lord, Sally ; Finn, Richard S. ; Lim, Elgene ; Martin, Andrew ; Loi, Sherene ; Lynch, Jodi ; Friedlander, Michael ; Lee, Chee Khoon
  • Subjects: Abemaciclib ; Analysis ; Asian people ; Asians ; Breast cancer ; Brief Report ; Care and treatment ; Clinical trials ; Cyclin D ; Cyclin-dependent kinase 4 ; Cyclin-dependent kinases ; Endocrine therapy ; Ethnicity ; Medical schools ; Medicine ; Medicine & Public Health ; Minority & ethnic groups ; Oncology ; Palbociclib ; Pharmacogenetics ; Pharmacogenomics ; Ribociclib ; Toxicity
  • Is Part Of: Breast cancer research and treatment, 2019-02, Vol.174 (1), p.271-278
  • Description: Purpose Adding cyclin-dependent kinase (CDK) 4/6 inhibitor to endocrine therapy improves progression-free survival (PFS) in advanced breast cancer but the impact of ethnicity on efficacy and toxicity is unclear. We aimed to estimate the relative treatment efficacy and toxicity of endocrine therapy with and without CDK4/6 inhibitors, and compare between Asian/non-Asian subgroups. Method This meta-analysis included published first-line randomized trials comparing CDK4/6 inhibitor-endocrine therapy versus endocrine monotherapy. Hazard ratios (HR) and 95% confidence intervals (CI) for the overall population and Asian/non-Asian subgroups were extracted. The inverse-variance-weighted method was used to pool treatment estimates of PFS. Results Four trials ( N  = 2499) were included. Patients received combination CDK4/6 inhibitor-endocrine therapy ( N  = 1441; ribociclib, [46.4%]; palbociclib, [30.8%]; or abemaciclib, [22.8%]) versus endocrine monotherapy ( N  = 1058). CDK4/6 inhibitor-endocrine therapy was associated with prolonged PFS compared with endocrine monotherapy (HR 0.56; 95% CI 0.50–0.62). In Asians ( N  = 492), PFS HR was 0.39 (95% CI 0.29–0.51, P  < 0.0001). In non-Asians ( N  = 2007), PFS HR was 0.62 (95% CI 0.54–0.71, P  < 0.0001). There was a significant treatment-by-ethnicity interaction ( P  = 0.002). Toxicity data by ethnic subgroup were only available from two trials ( n  = 1334) with no convincing evidence that the risk of toxicity between CDK4/6 inhibitor-endocrine therapy and endocrine monotherapy varied by ethnicity. Conclusion Adding CDK4/6 inhibitor to endocrine therapy prolongs PFS compared to endocrine therapy alone as first-line treatment in advanced breast cancer. The magnitude of PFS benefit is ethnicity-dependent but there is no interethnic differences in relative treatment-related toxicities. These findings may assist in the design and interpretation of trials, inform economic analyses, and stimulate pharmacogenomic research.
  • Publisher: New York: Springer US
  • Language: English
  • Identifier: ISSN: 0167-6806
    EISSN: 1573-7217
    DOI: 10.1007/s10549-018-5054-x
    PMID: 30465154
  • Source: AUTh Library subscriptions: ProQuest Central
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