Efficiency and tolerability of abemaciclib in elderly patients

Abstract

Elderly cancer patients represent a very heterogeneous population not only in chronological age, but also in functional status, concomitant diseases and therapy, geriatric syndromes, and, as a consequence, in the tolerability of cancer treatment. The choice of treatment for metastatic breast cancer (mBC) in this category of patients is often a difficult task for oncologists. The emergence of a new class of drugs, inhibitors of cyclin-dependent kinases 4/6 (CDK4/6), has changed the paradigm of treatment of patients with luminal HER2 negative mBC (ER + HER2mBC); however, data on the efficacy and tolerability of these drugs in elderly patients are limited. Pooled subgroup analyzes of studies with CDK4/6 have shown that elderly patients with ER + HER2breast cancer have a clear PFS benefit from the addition of targeted drugs to hormonal therapy. Adverse events are observed more often in combination therapy with increasing age, which requires dose modification and appropriate therapy. In this regard, the drug abemaciclib is very attractive, which is characterized by a lower frequency of neutropenia compared to other CDK4/6 inhibitors, but a higher incidence of diarrhea, which can be controlled by taking appropriate drugs and is not a reason for treatment discontinuation. Careful selection of patients is necessary when deciding on the appointment of any therapy to geriatric cancer patients. Only a comprehensive multidisciplinary approach will make it possible to maximally individualize the approach to the treatment of this difficult category of patients and minimize the likelihood that they will receive excessive or insufficient oncological treatment.