eCase - Holistic Treatment of Patients with HRpos HER2neg MBC and Comorbidities

Introduction

In this module, Sara A. Hurvitz, MD, FACP reviews the current treatment landscape, current guidelines for the use of CDK4/6 inhibitors, and available real-world data on risk factors and clinical complexities surrounding the management of patients with HR-positive/HER2-negative metastatic breast cancer (MBC) with preexisting comorbid conditions.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. A few questions will be asked twice: once at the beginning of the activity and then again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

How many people with breast cancer do you provide care for in a typical month?

A.
1-4
B.
5-10
C.
11-15
D.
16-20
E.
>20
F.
Not applicable

A 72-year-old woman presents with metastatic estrogen receptor (ER)-positive/HER2-negative breast cancer involving the liver and bones. She has a history of irritable bowel syndrome and hypertension for which she is currently receiving a diuretic agent. She also has a history of atrial fibrillation for which she takes amiodarone. She has right lower extremity deep vein thrombosis (DVT) and has completed 6 months of anticoagulation therapy. The patient has a history of depression and is currently receiving citalopram.

In your discussion with this patient with HR-positive/HER2-negative MBC and comorbid conditions who is considering a CDK4/6 inhibitor-based therapy, which of the following should be considered to achieve optimal outcomes whilst avoiding drug–drug interactions?

A.
Abemaciclib is associated with a risk of QTc prolongation, thus use of concomitant medications like citalopram and diuretics must be considered before prescribing abemaciclib
B.
Abemaciclib is associated with an increased risk of diarrhea and venous thromboembolic events (VTE), thus it is not an ideal option for this patient
C.
Palbociclib is contraindicated with citalopram, thus citalopram must be discontinued before prescribing palbociclib
D.
Abemaciclib, palbociclib and ribociclib are all associated with a risk of neutropenia, thus none of these CDK4/6 inhibitors should be used in a patient older than 65 years of age

How confident are you in planning communication strategies and utilizing shared decision-making to optimize patient–physician trust and understand patient goals when selecting MBC treatment?

A.
Not confident
B.
Low confidence
C.
Moderate confidence
D.
Confident
E.
Very confident

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Treating the Whole Patient: Understanding Needs of Patients With HR-Positive/HER2-Negative MBC and Comorbidities

Sara A. Hurvitz, MD, FACP

Activity

Introduction

How many people with breast cancer do you provide care for in a typical month?

In your discussion with this patient with HR-positive/HER2-negative MBC and comorbid conditions who is considering a CDK4/6 inhibitor-based therapy, which of the following should be considered to achieve optimal outcomes whilst avoiding drug–drug interactions?

How confident are you in planning communication strategies and utilizing shared decision-making to optimize patient–physician trust and understand patient goals when selecting MBC treatment?