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

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A Correction to this article was published on 14 July 2020

This article has been updated

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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Change history

  • 14 July 2020

    In the original publication of the article, under the Results section, subheading ���Patient survival���, the second sentence that reads as ���The 6-month PFS was 92.4%, 81.8%, and 93.3% and the one-year PFS was 72.0%, 88.9%, and 78.9% in Groups 1���3, respectively.��� should read as "The 6-month PFS was 82.8%, 75.0%, and 68.0% and the one-year PFS was 77.0%, 62.0%, and 63.8% in Groups 1���3, respectively.".

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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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Author notes

  1. Ahrong Ham and Min Hwan Kim have contributed equally to this work.

Authors and Affiliations

  1. Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Ahrong Ham, Min Hwan Kim, Gun Min Kim & Joohyuk Sohn

  2. Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jee Hung Kim

  3. Division of Breast Surgery, Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jee Ye Kim, Hyung Seok Park, Seho Park, Young Up Cho, Byeong Woo Park & Seung Il Kim

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  1. Ahrong Ham
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Correspondence to Joohyuk Sohn.

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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 183, 107–116 (2020). https://doi.org/10.1007/s10549-020-05750-y

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