Would you consider AI alone over CDK4/6 inhibitor combinations in older patients with breast cancer considering the subgroup analyses from MONALEESA-2 suggest less benefit in patients over 65?

In MONALEESA-2, 295 patients (44%) were ≥ 65 years of age, 150 were randomized to ribociclib + letrozole; and 145 received placebo + letrozole. 370 patients were <65 years of age, 184 were randomized to the ribociclib group, and 186 to the placebo group. The baseline characteristics were balanced be...

There are several factors to take into consideration when balancing the merits of treatment in older patients with metastatic ER-positive breast cancer.

First, we do know that disease characteristics and ER biology change with age, and older patients tend to have more ER-dependent tumors and more fav...

The relative benefit might be less, but AI+CDK 4/6i is still better than AI even in patients over 65, so would consider AI+CDK 4/6i in this population also. It would be particularly important to manage toxicity and drug-drug interactions in this population as patients are likely to have more co-morb...

Only in a patient with significant comorbidities not related to the cancer (like a recent stroke) or a very elderly patient with other competing causes of mortality, will I consider starting on an AI alone, with the potential to escalate to the combination if they progress. Subset analysis from PALO...