Palbociclib use with grade 3 neutropenia in hormone receptor-positive metastatic breast cancer

Abstract

Purpose

Neutropenia is the most common toxicity of CDK4/6 inhibitors, causing frequent dose interruptions. However, CDK4/6 inhibitor-induced neutropenia shows a benign clinical course in contrast to that caused by chemotherapy. Here, we investigated the safety of a new dose scheme for palbociclib, which avoids dose delays or reductions due to afebrile grade 3 neutropenia.

Methods

A consecutive cohort of ER( +)/HER2( −) advanced breast cancer patients who received palbociclib between 2017 and 2018 was analyzed. The patients were classified into Group 1 (patients who maintained palbociclib dose with afebrile grade 3 neutropenia), Group 2 (patients who experienced any dose modification with afebrile grade 3 neutropenia), and Group 3 (patients without afebrile grade 3 neutropenia). The primary endpoint was febrile neutropenia incidence; other toxicities were compared with those of the PALOMA-2 trial.

Results

Among the 107 patients, 54.2%, 22.4%, and 23.4% were classified into Groups 1, 2, and 3, respectively. There was no febrile neutropenia in Groups 1 and 2 during palbociclib treatment. Group 1 showed higher incidence of thrombocytopenia (all-grade, 32.8%; grade 3–4, 8.6%) than Group 2 and the PALOMA-2 data, but there was no bleeding related to thrombocytopenia. Group 1 showed higher incidence of all-grade non-hematologic adverse events than Group 2; only one grade 3 non-hematologic toxicity was observed in Group 1. There were no treatment-related hospitalizations or deaths in Group 1.

Conclusions

Thus, omitting palbociclib dose modification with afebrile grade 3 neutropenia is safe and tolerable without febrile neutropenia events. This scheme could be useful to avoid unnecessary reductions in palbociclib doses in future practice.

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Funding

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI19C0430).

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Correspondence to Joohyuk Sohn.

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The authors declare that they have no conflict of interest.

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This study was approved by the Institutional Review Board of Severance Hospital. All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki declaration.

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Informed consent was waived because this study is a retrospective medical chart review that has minimal level of risk.

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Ham, A., Kim, M.H., Kim, G.M. et al. Palbociclib use with grade 3 neutropenia in hormone receptor-positive metastatic breast cancer. Breast Cancer Res Treat (2020). https://doi.org/10.1007/s10549-020-05750-y

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Keywords

  • CDK4/6 inhibitors
  • Palbociclib
  • Neutropenia
  • Dose modification