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Management of toxicities associated with targeted therapies for HR-positive metastatic breast cancer: a multidisciplinary approach is the key to success
- Source :
- Breast Cancer Research and Treatment
- Publication Year :
- 2019
- Publisher :
- Springer New York LLC, 2019.
-
Abstract
- Purpose: Agents targeting HR-positive, HER2-negative locally advanced or metastatic breast cancer have improved patient outcomes compared with conventional single-agent endocrine therapy. Currently, approved targeted agents include everolimus and three CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib. Unlike the well-characterized and easily manageable safety profile of endocrine therapies, adverse events associated with targeted therapies are complex and potentially severe. Their prompt recognition and treatment, crucial for prolonged endocrine sensitivity and survival, may be challenging and requires a multidisciplinary effort and a good knowledge of drug interactions. Methods: We reviewed the current evidence on the drug safety of targeted agents for metastatic breast cancer currently used in clinical practice in Italy, supported by the clinical experience of Italian oncologists with expertise in the field. Results: All oncologists had used CDK4/6 inhibitors in clinical practice and/or within a clinical trial. The clinical management of toxicities, including dose adjustments, treatment interruptions, and concerns regarding special populations is discussed, and the management of relevant adverse events, related to individual agents and class-specific, toxicities is reviewed. Hematologic toxicities have the greatest impact on clinical management of the disease and on patients. Although toxicities associated with the new treatments result in more visits to the physician and more time and attention with patients, they are manageable, with no need for the oncologist to consult with specialist physicians. Conclusions: Based on the available evidence and current guidelines, we propose a series of practical recommendations for multidisciplinary clinical management of the various toxicities associated with the addition of targeted agents to endocrine therapy.
- Subjects :
- 0301 basic medicine
Cancer Research
Review
Disease
chemistry.chemical_compound
0302 clinical medicine
Ribociclib
Molecular Targeted Therapy
Abemaciclib
Clinical Trials as Topic
Disease Management
Metastatic breast cancer
Everolimu
Oncology
Receptors, Estrogen
030220 oncology & carcinogenesis
Female
Advanced breast cancer
Receptors, Progesterone
Breast Neoplasm
medicine.drug
Human
medicine.medical_specialty
Neutropenia
Drug-Related Side Effects and Adverse Reactions
Antineoplastic Agents, Hormonal
Protein Kinase Inhibitor
Breast Neoplasms
Palbociclib
03 medical and health sciences
Breast cancer
medicine
Biomarkers, Tumor
Humans
Everolimus
Intensive care medicine
Adverse effect
Protein Kinase Inhibitors
business.industry
medicine.disease
Clinical trial
030104 developmental biology
chemistry
MED/06 - ONCOLOGIA MEDICA
business
Drug-Related Side Effects and Adverse Reaction
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Breast Cancer Research and Treatment
- Accession number :
- edsair.doi.dedup.....e6c87540f06b0d05606d363dd5a66a79