Aromatase and CDK4/6 Inhibitor-Induced Musculoskeletal Symptoms: A Systematic Review.
Aromatase and CDK4/6 Inhibitor-Induced Musculoskeletal Symptoms: A Systematic Review.
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DOI：
10.3390/cancers13030465
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发表时间：
2021-01-26
期刊：
影响因子：
5.2
通讯作者：
Zagouri F
中科院分区：
文献类型：
--
作者：
Andrikopoulou A;Fiste O;Liontos M;Dimopoulos MA;Zagouri F
芳香化酶诱导的肌肉骨骼症状（AIMSS）发生在50%的绝经后患者中，是25%的乳腺癌患者停止治疗的原因。CDK 4/6抑制剂已被确定用于治疗激素受体阳性（HR）乳腺癌。我们的目的是评估CDK 4/6抑制剂治疗对AIMSS的影响。接受芳香酶抑制剂（AI）联合CDK 4/6抑制剂治疗的患者（5.8-33.3%）的关节痛发生率低于AI单药治疗（1-47%）。肌痛、背痛和骨痛在接受CDK 4/6抑制剂治疗的患者中也趋于减少。CDK 4/6抑制剂可能会减轻由AI引起的肌肉骨骼疼痛，尽管需要进一步的研究。背景资料：芳香化酶抑制剂（AIs）治疗是激素受体阳性乳腺癌女性的基本辅助治疗和转移治疗。尽管芳香化酶相关性肌肉骨骼综合征（AIMSS）被认为是一种耐受性良好的治疗方法，但它是乳腺癌患者遇到的最常见的不良事件。CDK 4/6抑制剂已成为转移性激素受体阳性乳腺癌的新治疗策略。然而，CDK 4/6抑制剂对AI引起的肌肉骨骼症状的影响尚未明确。目的：本系统性综述旨在确定转移性疾病中AI和CDK 4/6抑制剂治疗诱导的关节症状的频率。检索策略：通过检索2005/01/01-2021/01/01期间的现有文献识别出符合条件的文章;该算法由以下关键词的预定义组合组成：“乳腺”、“癌症”、“芳香酶抑制剂”、“CDK 4/6”、“III期”。选择标准：本研究按照PRISMA指南进行。所有评估第三代芳香化酶抑制剂（AI）和CDK 4/6抑制剂在绝经后妇女转移性疾病中的应用的随机对照III期试验（RCT）都被认为符合本综述的要求。数据收集：总体而言，检索到16项随机对照试验（RCT），其中9项研究探讨了转移性环境中AI的给药，7项研究探讨了CDK 4/6抑制剂和AI的联合用药。1-47%接受AI治疗的患者和5.8-33.3%接受CDK 4/6抑制剂治疗的患者报告了关节痛。接受AI治疗的患者中有2-23.7%发生肌痛，而接受CDK 4/6抑制剂治疗的患者中有4.8-11.9%发生肌痛。在接受AI和CDK 4/6抑制剂治疗的转移性疾病绝经后女性中，背痛的发生率分别为7-32.9%和2.9-8.5%。7-32.9%接受AI治疗的绝经后女性和2.9-8.5%接受CDK 4/6抑制剂治疗的女性报告了骨痛。结论：AI治疗诱导的肌肉骨骼综合征是一种不良事件，影响超过三分之一（20-47%）接受AI治疗的绝经后患者，通常导致治疗中止。来自RCT的数据提供证据表明，CDK 4/6抑制剂给药后肌肉骨骼症状的发生率相对降低。CDK 4/6抑制剂可能对AIMSS的发展起保护作用。
Aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) occurs in up 50% of postmenopausal patients and is the reason for treatment discontinuation in 25% of patients with breast cancer. CDK4/6 inhibitors have been established in the treatment of hormone receptor-positive (HR) breast cancer. We aimed to assess the effect of treatment with CDK4/6 inhibitors on AIMSS. Arthralgia rate was lower in patients receiving aromatase inhibitors (AIs) in combination with CDK4/6 inhibitors (5.8–33.3%) compared with monotherapy with AIs (1–47%). Myalgias, back pain and bone pain also tended to be reduced in patients treated with CDK4/6 inhibitors. CDK4/6 inhibitors may alleviate musculoskeletal pain caused by AIs, although further studies are warranted. Background: Treatment with aromatase inhibitors (AIs) is fundamental in women with hormone receptor-positive breast cancer in the adjuvant as well as the metastatic setting. Even though it is considered to be a well-tolerated therapy, aromatase inhibitor-associated musculoskeletal syndrome (AIMSS) is the most common adverse event encountered by breast cancer patients. CDK4/6 inhibitors have emerged as a new treatment strategy in metastatic hormone receptor-positive breast cancer. However, the impact of CDK4/6 inhibitors on musculoskeletal symptoms caused by AIs is not well-defined. Objectives: This systematic review aims to identify the frequency of joint symptoms induced by treatment with AIs and CDK4/6 inhibitors in the metastatic setting. Search strategy: Eligible articles were identified by a search of existing literature for the period 2005/01/01–2021/01/01; The algorithm consisted of a predefined combination of the following keywords “breast”, “cancer”, “aromatase inhibitors”, “CDK4/6”, “phase III”. Selection criteria: This study was performed in accordance with PRISMA guidelines. All randomized controlled Phase III trials (RCTs) evaluating the administration of third-generation aromatase inhibitors (AIs) and CDK4/6 inhibitors in postmenopausal women in the metastatic setting were considered eligible for this review. Data collection: Overall, 16 randomized control trials (RCTs) were retrieved, of which nine studies explored the administration of AIs in the metastatic setting and seven studies investigated the combination of CDK4/6 inhibitors and AIs. Arthralgia was reported in 1–47% of patients treated with AIs and 5.8–33.3% of patients treated with CDK4/6 inhibitors. Myalgias occurred in 2–23.7% of patients receiving AIs compared with 4.8–11.9% of patients treated with CDK4/6 inhibitors. The incidence of back pain was 7–32.9% vs. 2.9–8.5% in postmenopausal women with metastatic disease treated with AIs and CDK4/6 inhibitors, respectively. Bone pain was reported in 7–32.9% of postmenopausal women treated with AIs and 2.9–8.5% of women treated with CDK4/6 inhibitors. Conclusions: AI treatment-induced musculoskeletal syndrome is an adverse event affecting over one-third (20–47%) of postmenopausal patients treated with AIs that often leads to treatment discontinuation. Data from RCTs provide evidence that the incidence of musculoskeletal symptoms is relatively decreased upon CDK4/6 inhibitor administration. CDK4/6 inhibitors may provide a protective role against AIMSS development.
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DOI：
10.1200/jco.2015.61.5831
发表时间：
2015-11-10
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Ellis MJ;Llombart-Cussac A;Feltl D;Dewar JA;Jasiówka M;Hewson N;Rukazenkov Y;Robertson JF
通讯作者：
Robertson JF
影响因子：
45.3
作者：
Buzdar, A;Jonat, W;Plourde, PV
通讯作者：
Plourde, PV
影响因子：
45.3
作者：
Dombernowsky, P;Smith, I;Trunet, PF
通讯作者：
Trunet, PF
影响因子：
45.3
作者：
Chia, Stephen;Gradishar, William;Piccart, Martine
通讯作者：
Piccart, Martine
影响因子：
45.3
作者：
Goetz, Matthew P.;Toi, Masakazu;Di Leo, Angelo
通讯作者：
Di Leo, Angelo