Oncology Brothers: Practice-Changing Cancer Discussions Challenging Cases in Breast Cancer with CDK 4/6 Inhibitors – Drs. Sara Tolaney & Adam Brufsky
Nov 24, 2025
Dr. Sara Tolaney, a breast cancer researcher at Dana-Farber, and Dr. Adam Brufsky from UPMC Hillman, dive into the latest advancements in CDK4/6 inhibitors. They discuss key trial updates, recommending abemaciclib for high-risk patients and exploring dosing strategies to manage side effects like diarrhea and neutropenia. Insights on tailoring treatment for metastatic cases and considering patient comorbidities highlight the importance of individualized care. Expect expert opinions on navigating the complexities of breast cancer therapeutics!
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Adjuvant Trial Outcomes Differ
- MonarchE showed abemaciclib improved invasive disease-free survival and later demonstrated an overall survival benefit at seven years.
- NATALEE showed ribociclib improved disease-free survival with overall survival data pending.
Long Endocrine Therapy For High-Risk Patients
- Offer at least 7–10 years of aromatase inhibitor therapy for high-risk postmenopausal ER-positive patients.
- Integrate adjuvant CDK4/6 inhibition (preferably abemaciclib) for patients meeting trial criteria.
Manage Abemaciclib Diarrhea Proactively
- Start abemaciclib at 150 mg BID per label but reduce to 100 mg BID for persistent diarrhea or frail patients.
- Use dose reductions rather than abandoning CDK4/6 therapy when toxicity emerges.