SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Breast Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1577075
Real-world effectiveness and safety of CDK4/6i in elderly and BIPOC patients with HR+/HER2-advanced/metastatic breast cancer: An updated systematic literature review
Provisionally accepted
Nadia Harbeck1
Adam Brufsky2
Chloe Grace Rose3
Beata Korytowsky3
Connie Chen3Krista Tantakoun4
Endri Jazexhi4
Vien Do4Meaghan Bartlett4
Imtiaz Samjoo4*Timothy Pluard5- 1Breast Center, Department of Gynecology & Obstetrics & Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
- 2UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, United States
- 3Pfizer, New York, New York, United States
- 4Eversana, Burlington, Ontario, Canada
- 5St. Luke's Cancer Institute, Kansas City, United States
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The HR-positive/HER2-negative (HR+/HER2-) advanced/metastatic breast cancer (a/mBC) treatment landscape has advanced with cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), yet outcome disparities persist, particularly among older patients and black, indigenous, and people of color (BIPOC) communities. Emerging real-world evidence (RWE) since 2021 highlights the need for this updated systematic literature review.Methods: Searches were conducted in MEDLINE®, Embase®, and Cochrane Databases (07/06/2019-01/09/2024) and key congress proceedings (2020)(2021)(2022)(2023)(2024). Studies on CDK4/6i treatment in elderly and BIPOC patients with ≥100 participants and details on therapy line and CDK4/6i type were included. Key outcomes for synthesis were effectiveness, treatment patterns, and safety.Results: This review included 23 unique studies. In comparisons of CDK4/6is among elderly patients, palbociclib and ribociclib demonstrated similar effectiveness, whereas data for abemaciclib were limited. These findings aligned with single-arm studies and CDK4/6i versus endocrine therapy (ET) comparisons, which demonstrated superior survival benefits for CDK4/6is over ET alone in both elderly and BIPOC subpopulations. Despite higher discontinuation rates and neutropenia in both subpopulations, survival outcomes remained unaffected in studies assessing effectiveness and tolerability.Conclusions: This review highlights that CDK4/6is are effective and well-tolerated in elderly and BIPOC patients with HR+/HER2-a/mBC. It also underscores the expanding body of RWE supporting CDK4/6is, highlighting their global use and key role in guiding clinical decisions, particularly for patient subpopulations underrepresented in clinical trials.
Keywords: CDK4/6i, Breast, metastasis, Real-world evidence, Systematic Literature Review, Elderly, BIPOC
Received: 14 Feb 2025; Accepted: 23 Jul 2025.
Copyright: © 2025 Harbeck, Brufsky, Grace Rose, Korytowsky, Chen, Tantakoun, Jazexhi, Do, Bartlett, Samjoo and Pluard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Imtiaz Samjoo, Eversana, Burlington, Ontario, Canada
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