Editor's Note: in choosing CDK4/6 inhibitors for adjuvant intensified treatment in HR+/HER2- breast cancer patients, do you prefer abemaciclib or ribociclib? At the 2024 Breast Cancer Summer Forum·Northern Salon "In-Depth Analysis" session, Dr. Shu Liu from The Affiliated Hospital of Guizhou Medical University and Dr. Li Ma from The Fourth Hospital of Hebei Medical University shared their viewpoints. Dr. Shu Liu indicated a preference for abemaciclib, while Dr. Li Ma preferred ribociclib. After the session, Oncology Frontier invited both experts to elaborate on their perspectives.Presenting Views and Analyzing Reasons
Dr. Shu Liu: Choosing Abemaciclib
For adjuvant intensified treatment in HR+/HER2- breast cancer patients, I prefer abemaciclib for the following reasons: First, the relevant study (monarchE study) included a higher-risk patient population, aligning well with clinical practice in China. Second, its safety is controllable. Third, it is recommended by more guidelines. Fourth, it is included in China’s medical insurance directory, making it accessible to more patients.
Dr. Li Ma: Choosing Ribociclib
For adjuvant intensified treatment in HR+/HER2- breast cancer patients, I prefer ribociclib for the following reasons: First, in the NATELEE study, ribociclib covers a broader patient population, including some high-risk N0 patients who also have a recurrence risk and can benefit from intensified treatment with ribociclib. Second, ribociclib has fewer side effects, making it relatively easier to manage and its safety is controllable. The incidence of perceivable adverse reactions (such as diarrhea) is lower with ribociclib. Third, the treatment duration with ribociclib aligns with the basic concept of endocrine therapy. A three-year treatment period can cover the peak recurrence and metastasis period for HR+ breast cancer.
Debating Points and Techniques
Dr. Shu Liu: For high-risk recurrence patients, if both abemaciclib and ribociclib indications are simultaneously covered, would you still choose ribociclib in clinical practice, given that abemaciclib is included in medical insurance?
Dr. Li Ma: This is a sharp and practical clinical question. Indeed, ribociclib currently not being included in medical insurance lacks sufficient advantages from a pharmacoeconomic perspective. Therefore, I hope that through our debate, we can draw attention to this issue and prompt ribociclib to be included in the medical insurance coverage soon, benefiting more patients.
Dr. Li Ma: The occurrence of diarrhea during abemaciclib treatment is relatively common. Does this influence your clinical choice of medication?
Dr. Shu Liu: Indeed, the occurrence of diarrhea during abemaciclib treatment is often criticized. However, abemaciclib offers different dosage options, such as 50 mg, 100 mg, and 125 mg, allowing us to adjust the dosage to resolve diarrhea issues during treatment. Additionally, the expert group of the Chinese Society of Clinical Oncology (CSCO) Breast Cancer Expert Committee has developed a consensus on managing adverse events associated with CDK4/6 inhibitors. This consensus combines clinical experience and references domestic and international research progress, providing management measures for common adverse reactions of CDK4/6 inhibitors. For patients using CDK4/6 inhibitors, issues can be minimized through preventive measures before medication, monitoring during medication, comprehensive management, and proper education throughout the treatment process.
Vote
In choosing CDK4/6 inhibitors for adjuvant intensified treatment in HR+/HER2- breast cancer patients, do you prefer abemaciclib or ribociclib? (Single choice)
- Abemaciclib
- Ribociclib
- Abstain
Dr. Shu Liu
Chief Physician, Doctor of Medicine, Doctoral Supervisor Deputy Director of the Breast Surgery Department, The Affiliated Hospital of Guizhou Medical University , Head of the Second Ward of Breast Surgery Primary Physician of Medical Aesthetics, National Level II Psychological Consultant Member of the Breast Professional Committee of the Chinese Society of Clinical Oncology (CSCO) Member of the Breast Cancer Professional Committee of the China Anti-Cancer Association (CBCS) Member of the Breast Cancer Group of the Oncology Branch of the Chinese Medical Doctor Association Standing Committee Member of the Breast Cancer Multidisciplinary Diagnosis and Treatment Group of the China Medical Education Association Deputy Leader of the Body Surface Tumor Plastic Surgery Group of the Reconstruction Surgery Professional Committee of the China Rehabilitation Medicine Association Standing Committee Member of the Breast Disease Professional Committee of the China Maternal and Child Health Association Deputy Director of the Yangtze River Academic Belt Breast Cancer Alliance (YBCSG) Deputy Director of the Breast Cancer Individualized Diagnosis and Treatment and MDT Professional Committee of the Beijing Cancer Prevention and Treatment Society Deputy Director and Secretary-General of the Breast Cancer Professional Committee and Youth Committee of the Guizhou Anti-Cancer Association Deputy Director of the Breast Plastic Surgery Branch of the Guizhou Plastic Surgery Association Editorial Board Member of JCO Chinese Edition and Chinese Journal of Breast Disease
Dr. Li Ma
Chief Physician, Professor, Doctor, Postdoctoral Fellow of the Third Military Medical University Doctoral Supervisor Director of the Breast Center Ward, Fourth Hospital of Hebei Medical University Member of the Breast Cancer Professional Committee of the China Anti-Cancer Association Member of the Breast Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO) Standing Committee Member of the Breast Disease Professional Committee of the China Medical Education Association Deputy Secretary-General of the Hebei Tumor Prevention and Treatment Federation Chairman-elect of the Breast Cancer Professional Committee of the Hebei Tumor Prevention and Treatment Federation Chairman-elect of the Breast Cancer Expert Committee of the Hebei Clinical Oncology Society Standing Committee Member of the Breast Cancer Professional Committee of the Hebei Anti-Cancer Association Chairman of the Youth Committee of the Breast Cancer Professional Committee of the Hebei Anti-Cancer Association
