CDK4/6 Inhibitors Show Promise in Visceral Crisis, Offer treatment Options for Node-Positive breast Cancer Patients
New data suggests CDK4/6 inhibitors may be a viable choice to customary chemotherapy for patients experiencing visceral crisis due to metastatic breast cancer, while their role in early-stage, node-positive disease continues to expand treatment personalization.
Patients presenting with visceral crisis - a severe illness requiring hospitalization and often involving organ dysfunction like elevated liver enzymes or pleural effusions – historically have been treated with chemotherapy. Though, National Comprehensive Cancer Network (NCCN) guidelines now acknowledge the potential use of CDK4/6 inhibitors combined with aromatase inhibitors in cases of extensive visceral involvement, though clear definitional criteria for “visceral crisis” remain elusive.
the RIGHT Choice trial offers some support for this approach, demonstrating benefit compared to physician’s choice chemotherapy. Though,researchers note the trial’s limitations,including a small sample size,imprecise definitions of visceral crisis,and the exclusion of patients with liver enzyme elevations – a common symptom in these cases. The inherent difficulty in conducting large, randomized trials in emergency settings, coupled with ethical concerns, makes further phase III studies unlikely. Thus,treatment decisions must be individualized,factoring in expected response times and the hepatic metabolism of CDK4/6 inhibitors.
Beyond crisis management,CDK4/6 inhibitors are increasingly relevant in early-stage breast cancer treatment,particularly for patients with positive lymph nodes. Both the monarchE and NATALEE trials included node-positive participants, making abemaciclib or ribociclib potential options for those with any lymph node involvement. When patients meet the criteria for both agents, treatment selection should be guided by a detailed risk factor analysis based on the trial protocols, alongside individual patient considerations such as adverse effect profiles, comorbidities, tolerability, and adherence potential.
