Moving Away from Chemotherapy to Treat HR-Positive/HER2-Negative Metastatic Breast Cancer

Looking at new data from the phase 3 PEARL trial, Dr. Melissa K. Accordino discusses how the use of CDK4/6 inhibitors could help patients with HR-positive/HER2-negative metastatic breast cancer move away from chemotherapy.

The use of CDK4/6 inhibitor Ibrance (palbociclib), in combination with either Aromasin (exemestane), which is an estrogen modulator, or the chemotherapy Faslodex (fulvestrant), shows promise for patients with hormone receptor (HR)—positive, HER2-negative metastatic breast cancer, according to Dr. Melissa K. Accordino.

Accordino, assistant professor of medicine in the Division of Hematology/Oncology at the Herbert Irving Comprehensive Cancer Center and Columbia University Medical Center, discussed the findings of the phase 3 PEARL trial in an interview with OncLive®, a sister publication to CURE®, that looked at data that showed no difference in efficacy in progression free survival (PFS) in both arms of the trial. Moreover, patients on the CDK4/6 inhibitor and endocrine therapy demonstrated that this treatment may be safer than the use of chemotherapy.

Accordino hopes that this data helps physicians move away from chemotherapy in this patient population where possible.


The PEARL trial was looking to see in patients who've had endocrine therapy in the metastatic setting, which is more effective palbociclib, which is the CDK4/6 inhibitor, with either exemestane or fulvestrant compared to capecitabine, which is chemotherapy.

That study shows that there really wasn't a difference in advocacy in regards to progression free survival, but the side effect profiles were a little bit different, but what this tells us is among those patients who have already progressed on endocrine therapy, that a CDK4/6 inhibitor and endocrine therapy might be an option over chemotherapy. So, we don't always have to rush to chemotherapy.

The time to response was also similar in both of those arms, which is reassuring. Chemotherapy is definitely an option for our patients. And as our patients are living longer and longer, we're now able to give more and more treatment. I think though, as this data suggests, we should try and exhaust all other options before reaching for chemotherapy, if it makes sense for our patients.