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
Bibliographic record
Abstract
Background and aim: 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: , and Cochrane Databases (07/06/2019-01/09/2024) and key congress proceedings (2020-2024). 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".