Shahid Gilani, MD from University Hospital Of North Midlands discusses the abstract Palbociclib in real world practice before and during COVID-19 pandemic at University Hospitals of North Midlands (UHNM) in the United Kingdom.
 Context
The use of palbociclib in metastatic breast cancer (MBC) was studied during the COVID-19 pandemic era, outlining the course and impact of the disease. Extreme acute respiratory syndrome associated with coronavirus 2 (SARS-CoV-2) disease (COVID-19) developed this year globally causing an overload of the hospital system1 in patients with significant influx2 leading to disruption of routine care3. The difficulty posed for patients by travel restrictions4. Oral therapy was found to be more effective 4. This contributed to the evolution of fast guidelines5. Endocrine-based therapy has been prescribed for the vast majority of patients with ER+/HER2 negative MBC5. Because of their immunosuppressive effects, the most difficult decision was to add CDK 4/6 inhibitors5, while recent major studies have shown a genuine benefit of CDK 4/6 inhibitors (Palbociclib, Ribociclib, Abemaciclib)6. Neutropenia7, making the decision challanging5, remained the major side effects, primarily of Palbociclib and Ribociclib.
Methodology
Retrospective electrical database check to identify and analyze the clinical use of palbociclib during March 2020 to June 2020 COVID-19 period, compared to the UHNM non-COVID-19 period.
Outcomes
During the COVID-19 period, a total of 32 patients received palbociclib, 75 percent began with an aromatase inhibitor, and 25 percent with Fulvestrant. Sixty-eight years of age, 50 percent over 70. Ages and unique sites of disease were comparable; however, during COVID-19, large patients had visceral disease. Average Cycle Number 10. In 50 percent, three had disease progression radiological response seen. One had intermediate evidence of infection with COVID-19. No patients had signs of COVID-19. In 68 percent, the visceral disease was seen and 80 percent had mild to severe co-morbidities. The success status of ECOG was 0-2. Starting dose of 125 mg daily and first dose reduction (100 mg) due to grade 3 neutropenia in 20 percent of patients. A second dose reduction (75 mg) was observed in two patients due to delayed neutropenia after 5 cycles. Cancer antigen 15-3 (CA 15-3) was 40 percent natural. Results for the non-COVID-19 era were compared.
Completion
Palbociclib was well tolerated by patients during the COVID-19 pandemic, with no substantial effects on patients or facilities. Palbociclib’s key side effects were moderate immunosuppression requiring dose change. Although the evidence is limited, palbociclib is still supported in first-line or second-line settings during the COVID-19 pandemic in ER+/HER2 negative metastatic breast cancer patients.
Declaration of Effects
Palbociclib was exceptionally well tolerated during the pandemic of COVID-19.