Risk of neutropenia and healthcare resource utilization in patients with metastatic breast cancer treated with CDK4/6 inhibitors in real-world setting
Abstract: Introduction: In patients with metastatic estrogen-receptor (ER) positive breast cancer, the current standard of care as first or second line treatment is a combination of endocrine therapy with a CDK 4/6-inhibitor. Neutropenia is a dose-limiting toxicity of CDK 4/6 inhibitors leading to dose adjustment and treatment discontinuation in a considerable number of patients. The healthcare resource utilization pattern due to neutropenia in patients treated with CDK 4/6 inhibitors has not been studied in real-world setting. Aim: To identify the rate of neutropenia in breast cancer patients treated with CDK4/6 inhibitors palbociclib or ribociclib in clinical practice, and investigate the healthcare resource utilization between the two types of CDK 4/6 inhibitors as well as between patients with neutropenia versus those without neutropenia. Method: A retrospective cohort study based on electronic medical records of all patients with ER-positive breast cancer patients treated with CDK 4/6 inhibitors at the Department of Oncology at Örebro University Hospital, between January 2018 and June 2020 was performed. Results: Sixty-nine patients were included in the study cohort. The rate of grade III-IV neutropenia was 65%. No statistically significant difference between palbociclib and ribociclib was observed regarding rate of neutropenia or healthcare resource utilization. The mean number of extra blood analyses (2.04 vs. 0.13; p-value < 0.001) and the mean number of extra telephone contacts (1.69 vs. 0.83; p-value = 0.013) were higher among patients who developed neutropenia compared to patients without neutropenia. No increased risk for in-person visits or hospitalization in patients with neutropenia was observed. Conclusion: The rate of neutropenia is high among patients treated with CDK 4/6 inhibitors in daily clinical practice but in accordance with the evidence from randomized trials. Some aspects of healthcare resource utilization are increased due to neutropenia. Healthcare providers need to organize their clinical practice based on the potential need to allocate specific healthcare resources for patients treated with CDK 4/6 inhibitors.
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